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Cigna Utilization Review Nurse Jobs (NOW HIRING)

Oscar Health

Utilization Review Nurse

Dallas, TX · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You will perform frequent case reviews, check medical records and speak with care providers regarding ...

Oscar Health

Utilization Review Nurse

Miami, FL · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You will perform frequent case reviews, check medical records and speak with care providers regarding ...

Oscar Health

Utilization Review Nurse

Atlanta, GA · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You will perform frequent case reviews, check medical records and speak with care providers regarding ...

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You will perform frequent case reviews, check medical records and speak with care providers regarding ...

AbsoluteCARE

Utilization Review Nurse

New Orleans, LA · On-site

The Utilization Review Nurse ensures appropriate utilization of health services by performing initial, concurrent and retrospective clinical case reviews. This role collaborates and communicates with ...

AbsoluteCare

Utilization Review Nurse

New Orleans, LA · On-site

The Utilization Review Nurse ensures appropriate utilization of health services by performing initial, concurrent and retrospective clinical case reviews. This role collaborates and communicates with ...

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Cigna Utilization Review Nurse information

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How much do cigna utilization review nurse jobs pay per hour?

As of Jul 26, 2026, the average hourly pay for cigna utilization review nurse 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 are some typical daily responsibilities of a Cigna Utilization Review Nurse?

As a Cigna Utilization Review Nurse, you will review patient medical records to determine the necessity and appropriateness of hospital admissions, treatments, and services based on clinical guidelines. You'll interact with healthcare providers, case managers, and sometimes members to obtain additional information, clarify care plans, and ensure timely authorizations. Most of your work will involve thorough documentation, use of specialized software, and adherence to regulatory and company protocols. The role is primarily office-based or remote, offering structured hours, and you’ll be part of a collaborative team focused on ensuring high-quality, cost-effective patient care.

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

To thrive as a Cigna Utilization Review Nurse, you need a valid RN license, strong clinical assessment skills, and experience in utilization management or case review. Familiarity with medical management software, clinical guideline databases (such as Milliman or InterQual), and health insurance regulatory standards is crucial. Excellent written and verbal communication, critical thinking, and attention to detail help you effectively evaluate care needs and coordinate with healthcare providers. These competencies ensure accurate case reviews, regulatory compliance, and positive outcomes for both patients and the organization.

What is a Cigna Utilization Review Nurse job?

A Cigna Utilization Review Nurse evaluates medical services and treatments to ensure they meet established guidelines for medical necessity, cost-effectiveness, and policy compliance. They review patient records, coordinate with healthcare providers, and determine if requested procedures align with Cigna’s coverage criteria. This role helps manage healthcare costs while ensuring patients receive appropriate care. It typically involves collaboration with physicians, case managers, and claims specialists. Nurses in this role must have clinical experience, strong analytical skills, and knowledge of insurance policies.

More about Cigna Utilization Review Nurse jobs
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Cigna Utilization Review Nurse jobs near you
Infographic showing various Cigna Utilization Review Nurse job openings in the United States as of July 2026, with employment types broken down into 100% Full Time. Highlights an 75% In-person, and 25% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Utilization Review Nurse

Utilization Review Nurse

Health Business Solutions LLC

Cooper City, FL

Full-time

Posted 18 days ago

Job description

Job Summary: We are seeking a highly motivated and experienced Utilization Review Nurse to join our team. The Utilization Review Nurse will play a crucial role in supporting our clients in the healthcare industry by providing expert clinical guidance, facilitating effective utilization management, and ensuring revenue cycle efficiency. This position offers a unique opportunity to combine clinical expertise with revenue cycle management knowledge.

Key Responsibilities:

· Clinical Assessment: Conduct comprehensive clinical assessments of medical records to ensure patients are receiving appropriate care at the correct level of service.

  • Care Coordination: Collaborate with interdisciplinary healthcare teams to coordinate patient care and treatment plans, ensuring the most cost-effective and clinically appropriate care is provided.
  • Revenue Cycle Management: Utilize clinical expertise to support revenue cycle processes, including accurate coding, documentation improvement, and compliance with healthcare regulations.
  • Utilization Review:

a) Apply medical necessity screening criteria and clinical knowledge to ensure appropriateness of admissions and length of stays

b) Conduct initial admission, continuing stay, and 23-hour observations reviews for all patients

c) Support Utilization Review Coordinator team members on cases escalated for level of care determinations

d) Screen cases for Physician Advisor review

e) Collaborate with insurance companies on concurrently denied and high risk for denial cases

  • Documentation Improvement: Identify opportunities for improving clinical documentation to support accurate coding and billing processes, ultimately improving reimbursement.


  • Data Analysis: Analyze clinical and financial data to identify trends, opportunities for improvement, and areas of potential cost savings for clients.


  • Compliance: Stay up-to-date with healthcare regulations, guidelines, and policies to ensure all patient care and revenue cycle processes are in compliance with industry standards and regulatory requirements to ensure appropriate reimbursement.

Qualifications:

· Registered Nurse (RN) licensure required; must hold a USRN multi-state/compact nursing license.

· Bachelor of Science in Nursing (BSN) preferred.

· Case Management Certification (e.g., CCM) is a plus.

· Minimum of 3 years of clinical nursing experience, preferably in a hospital or acute care setting.

· Minimum 2 years of work experience in Utilization Review

· Strong understanding of revenue cycle management and healthcare reimbursement.

· Proficiency in medical coding and clinical documentation improvement.

· Excellent communication, interpersonal, and teamwork skills.

· Ability to work independently and make sound clinical and financial decisions.

· Strong analytical and problem-solving skills.

· Proficient in using healthcare information systems and technology.

· Commitment to maintaining patient confidentiality and ethical standards.

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