Spectrum Healthcare Resources has a need for a Utilization Manager Registered Nurse (UMRN) . These ... remote positions, working entirely from the Nurse's home. The Nurse will be reviewing cases ...
Spectrum Healthcare Resources has a need for a Utilization Manager Registered Nurse (UMRN) . These ... remote positions, working entirely from the Nurse's home. The Nurse will be reviewing cases ...
Spectrum Healthcare Resources has a need for a Utilization Manager Registered Nurse (UMRN) . These ... remote positions, working entirely from the Nurse's home. The Nurse will be reviewing cases ...
Spectrum Healthcare Resources has a need for a Utilization Manager Registered Nurse (UMRN) . These ... remote positions, working entirely from the Nurse's home. The Nurse will be reviewing cases ...
Exercise Integration and Readiness Coordinator
Honolulu, HI · On-site +1
$86K - $198K/yr
Remote Work: No Job Number: R0247104 Location: Honolulu,HI,US Share job via: Share Exercise ... Support asset utilization planning, reconstitution activities, lessons learned collection, and ...
Exercise Integration and Readiness Coordinator
Honolulu, HI · On-site +1
$86K - $198K/yr
Remote Work: No Job Number: R0247104 Location: Honolulu,HI,US Share job via: Share Exercise ... Support asset utilization planning, reconstitution activities, lessons learned collection, and ...
Continuity of Operations Planner
Honolulu, HI · On-site +1
$86K - $198K/yr
Remote Work: No Job Number: R0245834 Location: Honolulu,HI,US Share job via: Share Continuity of ... utilization, and training and exercise execution. Understand and be able to apply a variety of ...
Continuity of Operations Planner
Honolulu, HI · On-site +1
$86K - $198K/yr
Remote Work: No Job Number: R0245834 Location: Honolulu,HI,US Share job via: Share Continuity of ... utilization, and training and exercise execution. Understand and be able to apply a variety of ...
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?
| 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.
What are the most commonly searched types of Cigna Utilization Review jobs in Hawaii?
The most popular types of Cigna Utilization Review jobs in Hawaii are:
What are popular job titles related to Cigna Utilization Review Remote jobs in Hawaii?
For Cigna Utilization Review Remote jobs in Hawaii, the most frequently searched job titles are:
What job categories do people searching Cigna Utilization Review Remote jobs in Hawaii look for?
The top searched job categories for Cigna Utilization Review Remote jobs in Hawaii are:
Full-time
Posted 21 days ago
Job description
Job Description
Spectrum Healthcare Resources has a need for a Utilization Manager Registered Nurse (UMRN). These will be completely remote positions, working entirely from the Nurse's home. The Nurse will be reviewing cases, educating patients on appropriate care and managing health care costs for the dependents of our Nation's Active Duty and eligible retirees.
The Nurse will be working remotely Monday through Friday, 8 hours per day.
Requirements
- Bachelors Nursing Degree
- At least one active state nurse license, preferably compact state licensure
- At least 2 years' experience working as a UMRN, preferably in a remote or hybrid environment.
- Possess current certification in either
- Completion of an accredited Certified Professional Utilization Review (CPUR) program
- Certified Case Manager (CCM) issued by the Commission for Case Manager Certification.
--OR--
- Possess two (2) years of full-time broad based registered nurse experience in a utilization management review or a case management setting within the preceding five (5) years. Notwithstanding the aforementioned experience requirements, the HCWs must have pertinent clinical experience within the past two (2) years sufficient to demonstrate current clinical competency for the setting and procedures required by this contract.
- Highly organized, self-directed worker able to function in a high-volume environment without distractions.
- Strong verbal and written communication skills.
- Proficient level of experience with Microsoft Office applications and strong technical aptitude.
- Must have access to secure, high speed internet.
Company Overview:
Spectrum Healthcare Resources (SHR) was established in 1988 to deliver systems and processes designed to meet the unique needs of Military and VA Health Systems. SHR is a leading organization that provides physician and clinical staffing and management services to United States Military Treatment Facilities, VA clinics and other Federal Agencies through various contracting vehicles. A Joint Commission Health Care Staffing Services firm, SHR is the military staffing division of TeamHealth, a Nationwide organization that serves 850 civilian and military hospitals with a team of 9,600 affiliated health care professionals. EOE/Disabled/Veterans
Location : LocationUS-HI-HonoluluRecruiter : Full Name: First LastJoseph DayDirect phone number314-744-4138Recruiter : Emailjoseph_day@spectrumhealth.comEmployment Type: OTHER
About Spectrum Healthcare Resources
Sourced by ZipRecruiter
Spectrum is a leading organization that provides program management and physician and clinical staffing services to United States Military Treatment Facilities, VA Clinics and Federal Agencies. We are dedicated to the markets we serve, leading our organization’s experience for almost three decades.
Industry
Health care and social assistance
Company size
1,001 - 5,000 Employees
Headquarters location
Saint Louis, MO, US
Year founded
1988