Long Beach, CA · Remote
$30.37 - $59.21/hr
Adheres to utilization management (UM) policies and procedures. Required Qualifications At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization ...
Long Beach, CA · Remote
$30.37 - $59.21/hr
Adheres to utilization management (UM) policies and procedures. Required Qualifications At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization ...
San Jose, CA · Remote
$30.37 - $59.21/hr
Adheres to utilization management (UM) policies and procedures. Required Qualifications At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization ...
San Jose, CA · Remote
$30.37 - $59.21/hr
Adheres to utilization management (UM) policies and procedures. Required Qualifications At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization ...
Sacramento, CA · Remote
$30.37 - $59.21/hr
Adheres to utilization management (UM) policies and procedures. Required Qualifications At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization ...
Sacramento, CA · Remote
$30.37 - $59.21/hr
Adheres to utilization management (UM) policies and procedures. Required Qualifications At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization ...
Los Angeles, CA · Remote
$30.37 - $59.21/hr
Adheres to utilization management (UM) policies and procedures. Required Qualifications At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization ...
Los Angeles, CA · Remote
$30.37 - $59.21/hr
Adheres to utilization management (UM) policies and procedures. Required Qualifications At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization ...
San Diego, CA · Remote
$30.37 - $59.21/hr
Adheres to utilization management (UM) policies and procedures. Required Qualifications At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization ...
San Diego, CA · Remote
$30.37 - $59.21/hr
Adheres to utilization management (UM) policies and procedures. Required Qualifications At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization ...
San Francisco, CA · Remote
$70 - $100/hr
Remote Job Overview We are seeking experienced Hospitalist Physicians to contribute their medical ... Experience with utilization review, medical coding, or healthcare quality assurance. * Familiarity ...
Quick apply
San Francisco, CA · Remote
$70 - $100/hr
Remote Job Overview We are seeking experienced Hospitalist Physicians to contribute their medical ... Experience with utilization review, medical coding, or healthcare quality assurance. * Familiarity ...
Los Angeles, CA · Remote
$70 - $100/hr
Remote Job Overview We are seeking experienced Hospitalist Physicians to contribute their medical ... Experience with utilization review, medical coding, or healthcare quality assurance. * Familiarity ...
Quick apply
Los Angeles, CA · Remote
$70 - $100/hr
Remote Job Overview We are seeking experienced Hospitalist Physicians to contribute their medical ... Experience with utilization review, medical coding, or healthcare quality assurance. * Familiarity ...
Palo Alto, CA · Remote
$70 - $100/hr
Remote Job Overview We are seeking experienced Hospitalist Physicians to contribute their medical ... Experience with utilization review, medical coding, or healthcare quality assurance. * Familiarity ...
Quick apply
Palo Alto, CA · Remote
$70 - $100/hr
Remote Job Overview We are seeking experienced Hospitalist Physicians to contribute their medical ... Experience with utilization review, medical coding, or healthcare quality assurance. * Familiarity ...
San Jose, CA · Remote
$70 - $100/hr
Remote Job Overview We are seeking experienced Hospitalist Physicians to contribute their medical ... Experience with utilization review, medical coding, or healthcare quality assurance. * Familiarity ...
Quick apply
San Jose, CA · Remote
$70 - $100/hr
Remote Job Overview We are seeking experienced Hospitalist Physicians to contribute their medical ... Experience with utilization review, medical coding, or healthcare quality assurance. * Familiarity ...
San Jose, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
San Jose, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
San Diego, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
San Diego, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
Los Angeles, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
Los Angeles, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
San Francisco, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
San Francisco, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
San Jose, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
San Jose, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
Bakersfield, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
Bakersfield, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
San Diego, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
San Diego, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
Fresno, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
Fresno, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
Los Angeles, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
Los Angeles, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
Sacramento, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
Sacramento, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
... years utilization review/manage care experience Prior supervisory experience with the ability to ... Basic computer skills including Outlook, WORD, Microsoft suite and VPN or other remote access ...
... years utilization review/manage care experience Prior supervisory experience with the ability to ... Basic computer skills including Outlook, WORD, Microsoft suite and VPN or other remote access ...
| Aspect | Cigna Utilization Review Remote | Cigna Medical Reviewer |
|---|---|---|
| Credentials | RN or licensed healthcare professional | RN or licensed physician |
| Work Environment | Remote, telehealth setting | Remote or onsite, clinical setting |
| Employer & Industry | Cigna, health insurance industry | Cigna, healthcare and insurance industry |
| Primary Focus | Review of insurance utilization for appropriateness | Clinical 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.
The most popular types of Cigna Utilization Review jobs in California are:
For Cigna Utilization Review Remote jobs in California, the most frequently searched job titles are:
The top searched job categories for Cigna Utilization Review Remote jobs in California are:
Cities in California with the most Cigna Utilization Review Remote job openings:
Long Beach, CA • Remote
$30.37 - $59.21/hr
Full-time
Re-posted yesterday
8.0
Based on 199 frontline employees who took The Breakroom Quiz
171st of 315 rated insurance
JOB DESCRIPTION Job Summary
Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines.
Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members.
Processes requests within required timelines.
Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.
Requests additional information from members or providers as needed.
Makes appropriate referrals to other clinical programs.
Collaborates with multidisciplinary teams to promote the Molina care model.
Adheres to utilization management (UM) policies and procedures.
Required Qualifications
At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
Registered Nurse (RN). License must be active and unrestricted in state of practice.
Ability to prioritize and manage multiple deadlines.
Excellent organizational, problem-solving and critical-thinking skills.
Strong written and verbal communication skills.
Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
Certified Professional in Healthcare Management (CPHM).
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $30.37 - $59.21 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.
Health care and social assistance
10,000+ Employees
Long Beach, CA, US
1980
