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Cigna Utilization Review Nurse Jobs (NOW HIRING)

Fusion HCR

Utilization Review Nurse

Las Vegas, NV · On-site

Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in Acute Care. Overview Seeking an experienced Utilization Review Nurse (RN) to review patient admissions ...

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 ...

Seh

Summary The Utilization Review Nurse screens medical records in accordance with contractual agreement and regulatory requirements for medical necessity on admission and continued stay in the acute ...

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 ...

Southeast Health

Utilization Review Nurse

Dothan, AL · On-site

Summary The Utilization Review Nurse screens medical records in accordance with contractual agreement and regulatory requirements for medical necessity on admission and continued stay in the acute ...

Shannon Health

Utilization Review Nurse

Big Spring, TX · On-site

Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the ...

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

As of Jul 20, 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.

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Cigna Utilization Review Nurse jobs near you
Utilization Review Nurse

Utilization Review Nurse

Fusion HCR

Las Vegas, NV • On-site

Other

This job post has expired 7 days ago. Applications are no longer accepted.

Job description

Fusion HCR is hiring!Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in Acute Care.
Overview
Seeking an experienced Utilization Review Nurse (RN) to review patient admissions for medical necessity, appropriate level of care, and compliance with payer guidelines. This role works closely with clinical teams to ensure efficient resource utilization and quality patient outcomes.
Responsibilities
  • Review admissions using InterQual and/or Milliman criteria
  • Evaluate medical necessity, level of care, and documentation accuracy
  • Ensure compliance with Medicare, Medicaid, and regulatory guidelines
  • Collaborate with physicians, case management, and care teams
  • Support discharge planning and care coordination
  • Document findings and communicate recommendations

Requirements
  • Active RN license (Nevada)
  • 5+ years acute care nursing experience
  • 3+ years Utilization Review experience
  • 3+ years discharge planning experience (acute care)
  • Experience with InterQual (must be able to pass exam)
  • Experience with Milliman guidelines

Preferred
  • Background in Case Management or CDI
  • Strong knowledge of Joint Commission and CMS guidelines

Why Apply
  • Competitive pay
  • Stable, high-demand role
  • Collaborative healthcare environment

Apply Now
If you have strong Utilization Review, InterQual, and acute care experience, we want to hear from you!

Apply