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Cigna Utilization Review Remote Jobs in California

LIBERTY DENTAL

What You'll Do Utilization Management & Clinical Review ... Perform clinical reviews of dental claims and prior authorization requests across all lines of ...

Corvel

CA UR Case Manager II

Folsom, CA · Remote

$32.18 - $48.68/hr

The Utilization Review Case Manager gathers demographic and clinical information on prospective ... This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Identifies the necessity of ...

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Cigna Utilization Review Remote information

What is a Cigna Utilization Review Remote?

A Cigna Utilization Review Remote position involves evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to Cigna members—all while working from a remote location. Utilization Review professionals, often nurses or clinicians, review clinical information, make coverage determinations, and coordinate with providers to ensure members receive the right care. This role combines clinical expertise with knowledge of insurance guidelines and regulatory requirements, allowing for flexible work arrangements from home. It plays a critical role in managing healthcare costs and improving patient outcomes.

What are the key skills and qualifications needed to thrive as a Cigna Utilization Review Remote nurse?

To thrive as a Cigna Utilization Review Remote Nurse, you need a valid RN license, clinical experience (often in case management or utilization review), and a strong understanding of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic medical records (EMRs), and knowledge of Medicare/Medicaid policies or URAC/NCQA standards is typically required. Excellent critical thinking, attention to detail, and effective communication are crucial soft skills for evaluating medical necessity and coordinating with providers. These skills ensure accurate, compliant decisions that support patient care while managing healthcare costs efficiently in a remote environment.

What are some common challenges faced by Cigna Utilization Review professionals working remotely, and how can these be effectively managed?

Cigna Utilization Review professionals working remotely often encounter challenges such as maintaining clear communication with healthcare providers and team members, managing high caseload volumes, and staying updated on evolving clinical guidelines. To address these challenges, it’s important to leverage Cigna’s robust digital collaboration tools, participate actively in virtual team meetings, and utilize ongoing training resources. Setting a structured daily routine and prioritizing tasks can also help ensure timely and accurate reviews, while maintaining work-life balance in a remote setting.

What is the difference between Cigna Utilization Review Remote vs Cigna Medical Reviewer?

AspectCigna Utilization Review RemoteCigna Medical Reviewer
CredentialsRN or licensed healthcare professionalRN or licensed physician
Work EnvironmentRemote, telehealth settingRemote or onsite, clinical setting
Employer & IndustryCigna, health insurance industryCigna, healthcare and insurance industry
Primary FocusReview of insurance utilization for appropriatenessClinical assessment and direct patient care

While both roles involve healthcare review, Cigna Utilization Review Remote focuses on evaluating insurance claims remotely, whereas Cigna Medical Reviewer provides direct clinical assessments, often with more patient interaction. Both require healthcare credentials and are integral to Cigna's healthcare services, but their daily tasks and focus differ.

What are the most commonly searched types of Cigna Utilization Review jobs in California?

The most popular types of Cigna Utilization Review jobs in California are:

What are popular job titles related to Cigna Utilization Review Remote jobs in California?

For Cigna Utilization Review Remote jobs in California, the most frequently searched job titles are:

What job categories do people searching Cigna Utilization Review Remote jobs in California look for?

The top searched job categories for Cigna Utilization Review Remote jobs in California are:

What cities in California are hiring for Cigna Utilization Review Remote jobs?

Cities in California with the most Cigna Utilization Review Remote job openings:

Cigna Utilization Review Remote jobs near you
Infographic showing various Cigna Utilization Review Remote job openings in California as of August 2026, with employment types broken down into 86% Full Time, and 14% Contract. Highlights an 100% Remote job distribution.

Utilization Management RN - Optum West - Remote in PST or MST

UnitedHealth Group

Sacramento, CA • On-site, Remote

$29 - $52/hr

Full-time

Retirement

Posted 7 days ago

UnitedHealth Group rating

7.6

Company rating: 7.6 out of 10

Based on 146 frontline employees who took The Breakroom Quiz

191st of 898 rated healthcare providers

Job description

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.
Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. As a Utilization Management Nurse at UnitedHealth Group, you will make sure our health services are administered efficiently and effectively. You'll assess and interpret member needs and identify solutions that will help our members live healthier lives. This is an inspiring job at a truly inspired organization. Ready to make an impact?
Although this position is remote, applicants must be located in Pacific or Mountain Time Zones
If you are located in Pacific or Mountain time zones, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
  • Positions in this function require unrestricted compact RN licensure
  • Function is responsible for utilization management which includes Prior Authorization Review of skilled nursing facility, acute inpatient rehabilitation and long-term acute care hospital
  • Determines medical appropriateness of level of care following evaluation of medical guidelines and benefit determination
  • Generally, work is self-directed and not prescribed
  • Works with less structured, more complex issues
  • Identify solutions to non-standard requests and problems
  • Translate concepts into practice
  • Act as a resource for others; provide explanations and information on difficult issues

It feels great to have autonomy, and there's also a lot of responsibility that comes with it. In this role, you'll be accountable for making decisions that directly impact our members. And at the same time, you'll be challenged by leveraging technologies and resources in a rapidly changing, production-driven environment.
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
  • Compact RN License
  • 3+ years of Managed Care and/or clinical experience
  • Prior Utilization Management experience (not case management)
  • Proven basic computer skills with MS Outlook, Word and Excel

Preferred Qualifications:
  • Prior-authorization experience
  • Multi-specialty experience
  • Experience in a skilled nursing facility or inpatient rehabilitation facility
  • Multiple EMR experience including Epic, Cerner, TMC, Meditech or Care Advance
  • Knowledge of Milliman Criteria

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29.00 to $52.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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