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Cigna Utilization Review Remote Jobs in Idaho (NOW HIRING)

Vantor

Please review the job details below. Vantor is seeking an experienced ISR Collection Analyst to ... Monitor ISR collection activities to ensure effective utilization of available resources and ...

All JobsCigna Utilization Review JobsCigna Utilization Review Remote JobsCigna Utilization Review Remote Jobs in Idaho

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 popular job titles related to Cigna Utilization Review Remote jobs in Idaho?

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

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

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

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

Cities in Idaho 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 Idaho as of September 2026, with employment types broken down into 81% Full Time, 8% Part Time, and 11% Contract. Highlights an 100% Remote job distribution.

*New - Prior Authorization Specialist (Experienced)- Washington, Idaho, Oregon - Remote

Nyx Health

Boise, ID • On-site, Remote

$21 - $23/hr

Full-time

Medical, Dental, PTO

Posted 3 days ago

New

Job description

Prior Authorization Specialist - Remote - Idaho State
Position Summary
We're looking for a Prior Authorization Specialist with extensive, hands-on experience working insurance authorizations in EPIC. EPIC proficiency is mandatory. Extensive knowledge of Idaho payors is mandatory. This is not an entry-level training position, and candidates who require training on EPIC or lack significant experience working with Idaho payors will not be considered. The successful candidate must be able to step in and work independently from day one. You will be responsible for completing insurance verifications, submitting and tracking prior authorizations, gathering required documentation, communicating with insurance payors and clinicians, and following authorizations through to approval.
Key Responsibilities:
  • Extensive hands-on proficiency in EPIC, including prior authorization workflows.
  • Extensive knowledge of Idaho payors, including their authorization requirements, processes, and requirements.
  • Proven experience navigating complex insurance authorization requirements.
  • Ability to independently manage prior authorizations from submission through approval.
  • Communicate with providers and insurance companies regarding authorization status.
  • Maintain HIPAA compliance and support daily revenue cycle operations.

Skills & Qualifications
  • 5+ years of prior authorization experience -Required
  • Proficient EPIC
  • Strong communication, problem-solving, and organizational skills.
  • Detail-oriented, analytical, and able to multitask in a fast-paced environment.
  • Proficient in TEAMS

Education & Experience
  • High School Diploma required; additional education in business or healthcare preferred.
  • Experience in prior authorization, utilization review, insurance verification, and EMR systems.

[preferred]
Work Environment & Physical Requirements
  • Remote position
  • Prolonged computer use; ability to lift up to 15 lbs.
  • Reliable Internet
  • FT M-F - 40 hour work week - PST time zone
  • Hours available between 7am - 6pm

Job Type, Schedule & Compensation
Full-time, Monday-Friday, 8-hour day shift.
Pay: $21-$23 per hour, [With additional pay available for exceptional experience.]
High performers will also be eligible for a performance bonus incentive.
Benefits:
  • Dental insurance
  • Health Insurance
  • Accrued Paid Time Off

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