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Cigna Utilization Review Remote Jobs in Maine (NOW HIRING)

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 Maine?

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

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

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

Infographic showing various Cigna Utilization Review Remote job openings in Maine as of August 2026, with employment types broken down into 86% Full Time, 7% Part Time, and 7% Contract. Highlights an 100% Remote job distribution.

Remote Care Support Specialist - Hybrid

Maine Medical Center

Portland, ME • On-site, Remote

$21.97 - $29.28/hr

Full-time

Posted 5 days ago


Maine Medical Center rating

6.9

Company rating: 6.9 out of 10

Based on 57 frontline employees who took The Breakroom Quiz

549th of 1,061 rated hospitals


Job description

Description
Nursing/Clinical Support
Req #: 86842
The Remote Care Support Specialist is a hybrid role that combines in-person and remote patient support to advance technology-enabled post-acute care programs. This position engages patients at the bedside prior to discharge, enrolling them in remote monitoring and virtual care services, and then continues support at home through virtual outreach, technical assistance, and ongoing encouragement. Working closely with clinical teams and care coordinators, the Remote Care Support Specialist helps drive patient engagement, reduce readmissions, and improve outcomes through compassionate communication and effective use of digital health tools.
Mon-Friday 8am - 5pm. 2-3 days in-person/on-site
Summary:
The Remote Care Support Specialist role supports technology-enabled post-acute care programs designed to reduce hospital readmissions and emergency department utilization. This role is responsible for meeting with eligible patients in person at the hospital bedside prior to discharge, enrolling them in remote patient monitoring (RPM) and other virtual care programs, and ensuring a smooth onboarding experience. Following discharge, the Remote Care Support Specialist continues to engage patients at home by providing tech support, remote navigation assistance, and ongoing encouragement to remain active participants in their care.
Required Minimum Knowledge, Skills, and Abilities (KSAs)
  1. Education: High school diploma or equivalent.
  2. License/Certifications: Background as a Medical Assistant (MA), Certified Nursing Assistant (CNA), or Emergency Medical Technician (EMT) is required.
  3. Experience: Two years of experience in a health care setting in patient-facing healthcare roles with direct patient interaction.
  4. Additional Skills/Requirements Required: Comfort with digital health tools, smartphones/tablets, and basic technology troubleshooting. Excellent communication skills with the ability to explain technology in simple terms. Strong organizational skills and ability to manage multiple priorities independently. Demonstrated empathy, patience, and commitment to supporting patients across diverse backgrounds
  5. Additional Skills/Requirements Preferred: Experience with remote patient monitoring, virtual care, or chronic disease management programs. Bilingual or multilingual abilities. Familiarity with EHR documentation, patient engagement software, or monitoring dashboards.

Additional Information
MaineHealth is committed to fostering a supportive, inclusive environment where care team members can thrive while making a meaningful impact in the communities we serve across Maine and New Hampshire. We offer competitive benefits including paid parental leave, flexible work options, student loan assistance, professional development opportunities, and well-being resources-so you can grow your career while feeling supported both personally and professionally.
We recognize the value each team member brings to our organization. Any offer of employment will depend on qualifications such as skills, relevant experience, education, certifications, and other job-related factors. The base range is an estimate and does not reflect the full value of our total compensation package.
The pay range for this position is $21.97 to $29.28 per hour.
Compensation for part-time positions is determined on a prorated basis consistent with the scheduled hours and applicable full-time equivalent (FTE).
In addition to base pay, MaineHealth offers comprehensive benefits, recognition programs, career growth opportunities, and, where applicable, shift differentials or other incentives.
If you have questions about this role, please contact [email protected]
Hiring Scam Alert
MaineHealth will never request financial information during the interview or pre-hiring process. All legitimate communications will come from an email address ending in @mainehealth.org. If you suspect fraudulent activity, please report it immediately to [email protected] .
Notice Regarding Maine Employer Surveillance Statute: Pursuant to Maine's Employer Surveillance Statute, prospective care team members are notified that MaineHealth may monitor, collect, record, review, or retain information related to the use of its systems, networks, applications, files, data, communications platforms (including notified recordings), smart badges, building access, company vehicle GPS data, business calls, and workplace security cameras.
Information collected may be used for legitimate business purposes, including security, safety, compliance, investigations, training, quality assurance, and operational management.

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