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Cigna Utilization Review Remote Jobs in Georgia (NOW HIRING)

Build and present performance reviews and executive-ready reporting; drive corrective action plans ... Recommend technology improvements (automation, templates, dashboards, portal utilization) to ...

Electrical Engineering Department Head

Conyers, GA · On-site +1

$97K - $125K/yr

... Remote (Hybrid options available) About Raymond: We are a progressive, forward-thinking ... Monitor and manage departmental workload, utilization, staffing assignments, and resource planning.

Cloud Solution Architect

Atlanta, GA · Remote

$61 - $83.75/hr

Support hands-on delivery as needed, including Salesforce configuration, data loads, and review of ... Proven leadership of Salesforce delivery teams, including onshore/offshore models, remote teams ...

$27 - $29/hr

In this role, you'll ensure our Peer Review case reports are nothing short of exceptional ... The position is 100% remote with a schedule of Monday through Friday: * 12:00pm - 8:30pm EST ...

Showing results 21-40

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 cities in Georgia are hiring for Cigna Utilization Review Remote jobs?

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

Infographic showing various Cigna Utilization Review Remote job openings in Georgia as of August 2026, with employment types broken down into 85% Full Time, and 15% Contract. Highlights an 100% Remote job distribution.

(Remote) Team Lead, Account Follow-Up Services

Harris

Remote

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 15 days ago


Harris Computer rating

8.5

Company rating: 8.5 out of 10

Based on 10 frontline employees who took The Breakroom Quiz

81st of 247 rated software companies


Job description

MEDHOST, a division of Harris; is seeking an Account Follow-Up Services Team Leader who will provide strategic oversight of Hospital Insurance Follow-Up Services, including multi-team performance, payer strategy, denial prevention initiatives, workforce planning, and operational scaling.


This role drives measurable improvement in A/R aging, collections performance, and denial overturn rates through KPI leadership, cross-functional collaboration, training programs, continuous process innovation and adjust priorities on the fly.


This remote role welcomes candidates anywhere in the US. Preference will be given to candidates who can work in CST timezone.


Salary:

60K - 70K


AI & Innovation Mindset

We are committed to leveraging emerging technologies to improve how we work, serve our customers, and drive business outcomes. The successful candidate will demonstrate curiosity and a willingness to actively adopt and leverage AI tools to improve workflows, solve problems, and increase efficiency. Candidates should be comfortable using AI enabled technologies, including copilots, chat based AI assistants, and automation tools, as part of their everyday work while maintaining appropriate judgment, security, and compliance standards.


What your impact will be:

Operational & Performance Leadership

  • Own performance across one or more Insurance Follow-Up teams (or multiple clients).
  • Set daily/weekly/monthly targets for productivity, quality, and collections, ensuring adherence to service-level expectations.
  • Lead KPI governance (Days in A/R, A/R > 90, denial rate, overturn rate, net collection rate, first-pass resolution, productivity per FTE, quality).
  • Build and present performance reviews and executive-ready reporting; drive corrective action plans.

Denials Strategy & Payer Optimization

  • Lead payer trend analysis and root-cause programs to reduce preventable denials (eligibility, auth, coding/modifiers, timely filing, medical necessity, COB).
  • Standardize best practices for appeals, reconsiderations, and payer escalations.
  • Partner with leadership on payer playbooks and escalation pathways; ensure consistent documentation standards.

Training, Enablement & Quality Control

  • Design and maintain scalable training programs, SOPs, and payer-specific job aids.
  • Establish QA frameworks and audit cadence; monitor error trends and implement remediation plans.
  • Develop team leads and high-potential staff through structured coaching and succession planning.

Innovation & Process Improvement

  • Drive workflow optimization through queue design, inventory management, and prioritization strategies.
  • Recommend technology improvements (automation, templates, dashboards, portal utilization) to increase output and reduce rework.
  • Lead change management and adoption for new tools, payer policy updates, and client requirements.

Cross-Functional & Client Partnership

  • Collaborate with coding, payment posting, charge entry, eligibility, and client stakeholders to resolve systemic issues impacting AR.
  • Participate in client performance calls and support recovery plans for at-risk KPIs.

What we are looking for:

  • 3-5+ years of RCM experience with deep Insurance Follow-Up/Denials expertise.
  • 2-4+ years leading teams (supervisor/team lead/manager level).
  • Demonstrated success improving KPI outcomes (A/R aging reduction, denial reductions, increased overturn rate, improved collections).
  • Strong analytics/reporting capability (Excel required; dashboard/reporting tools preferred).
  • Advanced knowledge of payer behavior, denial categories, escalation processes, and appeals best practices.
  • Ability to travel when required to client site.
  • High Speed Internet access (minimum 300 Mbps download speed) and unlimited data.
  • Smart phone for Multi Factor Authentication (MFA) application.
  • Excellent communication skills (verbal & written), good judgement, tact, initiative, and resourcefulness.
  • Must be detail oriented, organized, and ability to multi-task.
  • Ability to demonstrate supportive relationships with peers, clients, partners, and corporate executives.
  • Must be flexible with a "can do" attitude and have the ability to remain professional under high pressure situations.

What we can offer:

  • 3 weeks' vacation and 5 personal days
  • Comprehensive Medical, Dental, and Vision benefits starting from your first day of employment
  • Employee stock ownership and RRSP/401k matching programs
  • Lifestyle rewards
  • Remote work and more!

About MEDHOST:

MEDHOST, founded in 1984 and headquartered in Franklin, Tennessee, is a leading provider of healthcare information technology solutions. Serving over 1,000 healthcare facilities nationwide, MEDHOST offers a comprehensive suite of products, including electronic health records (EHR), financial management systems, and patient engagement platforms. Their mission is to empower healthcare organizations to enhance patient care and improve business operations through innovative, user-friendly solutions. In January 2024, MEDHOST was acquired by N. Harris Computer Corporation, further strengthening its position in the healthcare IT industry.


About Harris:

Harris is a leading provider of mission critical software to the public sector in North America. As a wholly owned subsidiary of Constellation Software Inc. ("CSI", symbol CSU on the TSX), Harris has become the cornerstone for CSI's investment in utility, local government, school districts, public safety, and healthcare software verticals. Our success has been realized through investments in our proprietary software and market expertise. This focus, combined with acquiring businesses that build upon or complement our offerings, has helped drive our success. Harris will continue to growth through reinvestment - both in the people and products that we offer and making investments in acquiring new businesses.


#LI-remote


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Benefits

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Harris Computer Systems logo

About Harris Computer Systems

Sourced by ZipRecruiter

Harris Computer Systems, based in Ottawa, ON, CA, is an established player in the field of public sector software technology. Since its inception in 1976, the company has been striving to make clients' operations more efficient through reliable, practical, and flexible software solutions. Its extensive portfolio primarily serves utility, healthcare, public sector, and educational institutions, contributing to the betterment of public services through technology. Harris strongly believes in the value of forward-thinking technology and the power it has to drive progress for the public sector. This methodology is entirely in line with their mission to ensure customer success by providing reliable, practical, and robust software solutions.

Industry

Accounting services

Company size

1,001 - 5,000 Employees

Headquarters location

Ottawa, ON, CA

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