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Cigna Utilization Review Jobs (NOW HIRING)

Cigna

Medical Director - Neurologist

Experience in medical management, utilization review and case management in a managed care setting ... Fluency in Spanish (Cigna Medicare) or other languages If you will be working at home occasionally ...

Cigna

Medical Director - Urology - Evicore - Remote

Knowledge of applicable state and federal laws, Utilization Review Accreditation Commission and ... At The Cigna Group, you'll enjoy a comprehensive range of benefits, with a focus on supporting your ...

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How much do cigna utilization review jobs pay per hour?

As of Jul 11, 2026, the average hourly pay for cigna utilization review in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

What is a Cigna Utilization Review job?

A Cigna Utilization Review job involves evaluating medical treatments, procedures, and services to ensure they meet medical necessity and cost-effectiveness criteria. Utilization review specialists, typically nurses or healthcare professionals, assess patient records, verify insurance coverage, and collaborate with providers to determine appropriate care plans. They follow Cigna’s guidelines and policies to ensure compliance with healthcare regulations. This role helps manage healthcare costs while ensuring patients receive necessary and appropriate care.

What does a typical day look like for someone working in Cigna Utilization Review?

A typical day in a Cigna Utilization Review position involves reviewing clinical documentation, evaluating requests for medical procedures or services, and determining coverage based on established guidelines and policies. Professionals in this role regularly interact with healthcare providers, clinicians, and internal teams to clarify cases and support care coordination. The work is primarily desk-based and may be remote or in an office setting, and it requires staying up-to-date with regulatory changes and healthcare best practices. This role provides insight into the intersection of care delivery and insurance, offering opportunities for growth into leadership, quality assurance, or clinical policy development.

What are the key skills and qualifications needed to thrive in the Cigna Utilization Review position, and why are they important?

To excel in a Cigna Utilization Review role, you typically need a background in nursing or a related healthcare field, with an active RN license and experience in clinical assessment and case management. Familiarity with utilization management software, health insurance policies, and medical coding systems such as ICD-10 and CPT is often required. Strong analytical thinking, attention to detail, and effective communication skills are crucial for evaluating medical necessity and collaborating with providers. These competencies ensure accurate determinations, support high-quality patient care, and help maintain compliance with regulatory standards.

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Cigna Utilization Review jobs near you
Infographic showing various Cigna Utilization Review job openings in the United States as of July 2026, with employment types broken down into 1% Locum Tenens, 37% Full Time, 3% Part Time, 31% Contract, 27% Nights, and 1% Summer. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Utilization Review Specialist

Utilization Review Specialist

BriteLife Recovery

Englewood, NJ • On-site

Full-time

Re-posted 16 days ago

Job description

) What you will be doing?
The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is responsible for overseeing and coordinating all aspects of utilization review and insurance authorization for clients receiving substance use disorder (SUD) treatment at Britelife Recovery. This role ensures timely approvals and continued stay authorizations from insurance payers by effectively communicating clinical information and advocating for appropriate levels of care.
The UR Specialist works closely with clinical staff, admissions, medical providers, and third-party payers to support patient access to treatment and maintain financial viability for the organization. Success in this role requires strong clinical judgment, documentation skills, familiarity with ASAM criteria, and a working knowledge of insurance guidelines specific to behavioral health
What tasks are required?
  • Conduct initial and concurrent reviews for detox, residential, partial hospitalization (PHP), and intensive outpatient (IOP) levels of care.
  • Obtain prior authorizations and continued stay approvals from commercial and other payers by submitting timely clinical reviews and documentation.
  • Communicate clinical necessity of services based on ASAM criteria and DSM-5 diagnoses.
  • Track and document all insurance-related communications, decisions, and outcomes in the EHR and UR logs.
  • Collaborate with clinicians, therapists, case managers, and medical staff to gather accurate and up-to-date clinical information for reviews.
  • Ensure treatment plans, progress notes, and assessments are completed on time and accurately reflect medical necessity.
  • Participate in multidisciplinary team meetings to stay informed on client progress and treatment goals.
  • Assist staff with proper documentation practices to support insurance justification and compliance.
  • Maintain compliance with payer policies, HIPAA regulations, and internal utilization management protocols.
  • Monitor trends in denials, approvals, and length-of-stay metrics to support organizational performance improvement.
  • Assist in appeals and peer reviews by gathering required documentation and preparing clinical summaries.
  • Provide training and support to staff on documentation best practices related to utilization review.
  • Special projects as assigned

What we need from you?
  • Minimum of 2-3 years of experience in utilization review, case management, or insurance coordination in a behavioral health or substance use treatment setting.
  • Knowledge of ASAM criteria and levels of care for substance use and co-occurring disorders.
  • Familiarity with managed care principles, insurance authorizations, and payer requirements.
  • Bachelor's degree in Nursing, Social Work, Psychology, or a related field required; advanced degree or licensure (e.g., RN, LCSW, LPC, LMHC, or CADC) preferred.
  • Excellent organizational, communication, and time management skills.
  • Proficiency in Electronic Health Records (EHRs), insurance portals, and Microsoft Office tools.
  • Bachelor's degree in Nursing, Social Work, Psychology, or a related field required; advanced degree or licensure (e.g., RN, LCSW, LPC, LMHC, or CADC) preferred.
  • Experience or working knowledge with Collaborative MD and KIPU
  • Experience in detox and residential SUD programs.
  • Knowledge of major insurance provider platforms (e.g., Optum, Aetna, BCBS, Cigna).
  • Strong clinical writing skills and familiarity with medical necessity language.
  • Ability to advocate for clients while balancing payer relationships and compliance.
  • Ability to lift up to 25 pounds.
  • Ability to walk up and down stairs during emergency drills or situations.

All ARS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. ARS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success.

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