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Cigna Utilization Review Nurse Jobs (NOW HIRING)

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR, 97470, as needed for business operations. EMPLOYMENT TYPE: Full-Time, Exempt About Umpqua Health At ...

Umpqua Health

Utilization Review Nurse

$85K - $105K/yr

Utilization Review Nurse Remote Ability to travel on-site to 3031 NE Stephens St., Roseburg OR, 97457, as needed for business operations. Employment Type: Full-Time, Exempt About Umpqua Health At ...

Umpqua Health

Utilization Review Nurse

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR, 97457, as needed for business operations. EMPLOYMENT TYPE: Full-Time, Exempt About Umpqua Health At ...

Medix

Utilization Review Nurse

Southfield, MI · On-site

$42 - $46/hr

Job Summary Our client is seeking a Utilization Review Nurse. This role involves managing the full lifecycle of Independent Review Organization (IRO) cases, ensuring compliance with regulatory ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · Remote

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR, 97470, as needed for business operations. EMPLOYMENT TYPE: Full-Time, Exempt About Umpqua Health At ...

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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 Aug 10, 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 the 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 as a Cigna Utilization Review Nurse?

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?

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 August 2026, with employment types broken down into 5% As Needed, 90% Full Time, and 5% Part Time. Highlights an 81% In-person, and 19% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Nurse

Umpqua Health

Roseburg, OR • On-site, Remote

$85K - $105K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 8 days ago

Job description

UTILIZATION REVIEW NURSE
REMOTE
Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR, 97470, as needed for business operations.
EMPLOYMENT TYPE: Full-Time, Exempt
About Umpqua Health
At Umpqua Health, we're more than a healthcare organization-we're a community-driven Coordinated Care Organization (CCO) dedicated to improving the health and well-being of individuals and families throughout Douglas County, Oregon. We provide integrated, whole-person care through primary care, specialty care, behavioral health services, and care coordination. Our collaborative approach ensures members receive high-quality, personalized care while supporting a stronger, healthier community.
POSITION PURPOSE
The Utilization Management Nurse evaluates clinical service requests to ensure medically necessary, cost-effective, and evidence-based care for members. This role conducts prior authorizations, facilitates care coordination, and supports safe transitions across care settings, ensuring compliance with Oregon Health Plan (OHP), Medicare, and applicable regulations. The UM Nurse collaborates with interdisciplinary teams and community providers to promote integrated, high-quality care.
ESSENTIAL JOB RESPONSIBILITIES
  • Perform clinical assessments and prior authorizations to determine medical necessity
  • Escalate complex cases to Medical Directors and request additional documentation as needed
  • Collaborate with care coordinators, discharge planners, and interdisciplinary teams for care transitions
  • Liaise with internal departments to resolve eligibility, benefits, or service issues
  • Participate in discharge planning for members transitioning from acute, long-term, or residential care
  • Conduct audits and support quality improvement initiatives
  • Provide training and mentorship on UM protocols and workflows
  • Maintain relationships with community providers and service organizations
  • Ensure compliance with organizational policies, clinical standards, and federal/state regulations
  • Perform other nursing-related duties as assigned

CHALLENGES
  • Working with a variety of personalities, maintaining a consistent and fair communication style.
  • Satisfying the needs of a fast-paced and challenging company.

MINIMUM QUALIFICATIONS
  • Active, unrestricted RN license (BSN or MSN) in Oregon or a compact state
  • Graduation from an accredited nursing program
  • Minimum 5 years of direct patient care experience
  • Proficiency with Microsoft Office, EHR systems, and UM software
  • Strong clinical knowledge, communication, and organizational skills
  • No suspension, exclusion, or debarment from federal healthcare programs

PREFERRED QUALIFICATIONS
  • 2+ years of utilization review or case management experience in managed care
  • Oregon residency and license
  • Bilingual or translation skills a plus
  • Experience with quality improvement audits and diverse team collaboration
  • Ability to work independently in fast-paced environments
SCHEDULE
Monday through Friday - 8:00am - 5:00pm; standard business hours with flexibility to meet service timelines.
SALARY
Wage Band: $85,000- $105,340
BENEFITS
  • Salary is dependent on skills, experience, and education
  • Generous benefits package including vacation PTO, sick leave, federal holidays, and birthday leave
  • Medical, dental, and vision insurance
  • 401(k) with company match (fully vested immediately)
  • Company-sponsored life insurance and additional benefits
  • Fitness reimbursement program
  • Tuition reimbursement and more

Why Umpqua Health?
We are committed to advancing health equity by collaborating across communities, addressing systemic barriers, and ensuring fair access to care and resources. At Umpqua Health, every team member plays a vital role in making a meaningful impact, empowering healthier lives and strengthening the communities we serve.
Inclusive Culture
We foster a respectful, inclusive environment where employees feel valued, supported, and empowered.
Growth & Development
We support ongoing learning through mentorship, clear career pathways, and professional development opportunities.
Work/Life Balance
We promote flexibility and well-being so employees can thrive both professionally and personally.
Equal Opportunity
Umpqua Health is an equal opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and the needs of the business. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law.

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