2

Cigna Utilization Review Remote Jobs in Vermont (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 Vermont?

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

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

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

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

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

Remote Mental Health Counselor (Licensed) - Outpatient Services

InStride Health Associates

South Burlington, VT • Remote

$90K - $110K/yr

Full-time

Medical, PTO

Posted 6 days ago


Job description

Position Overview

InStride Health Associates is seeking a dedicated and passionate Remote Licensed Clinical Mental Health Counselor (LMHC) to provide telehealth services within our outpatient practice. This full-time role allows you to work from the comfort of your home while making a significant impact on the mental health and well-being of clients across Vermont. As an LMHC, you will engage directly with clients, offering them the support and guidance they need through various programs tailored to their unique needs.

About the Organization

At InStride Health Associates, we pride ourselves on our commitment to enhancing the mental health of our community. Our organization is comprised of a collaborative group of mental health professionals dedicated to providing evidence-based treatment in a compassionate and empathetic manner. Operating remotely from our outpatient office in South Burlington, Vermont, we focus on delivering personalized mental health care that responds to the evolving needs of our clients.

Work Environment

This remote position offers the flexibility and convenience of working from anywhere while being part of a supportive team of counselors and licensed practitioners. You will be involved in virtual sessions, utilizing telehealth platforms to effectively engage with clients. Our digital infrastructure ensures seamless communication, collaboration, and access to necessary patient information, fostering a dynamic and efficient remote working environment.

Key Responsibilities
  • Conduct thorough evaluations of clients seeking mental health services, assessing their treatment needs for both mental health and substance abuse issues.
  • Perform prior authorization reviews and concurrent evaluations, ensuring that clinical services are in line with established regulatory guidelines and are medically appropriate.
  • Analyze client behavioral health data to enhance the quality of care and assist in the appropriate utilization of our mental health services.
  • Provide education and resources to clients and their families regarding the process of behavioral health utilization, empowering them to make informed decisions about their care.
  • Collaborate with other healthcare providers to discuss treatment plans, levels of care, and integrate a multidisciplinary approach to patient service.
  • Engage in case presentations during staffing and integrated rounds, contributing to an ongoing dialogue about best practices in patient care.
  • Adhere strictly to organizational policies and continue to improve operational standards within our counseling practices.
  • Be proactive in performing other duties as assigned, contributing to a deep understanding of the operational landscape of behavioral health.
Patient Population / Client Focus

Your primary focus will be diverse individuals seeking mental health support, including those dealing with anxiety, depression, PTSD, and substance use disorders. With a strong commitment to inclusivity, you will work with clients from various backgrounds, tailoring therapeutic approaches to meet their unique cultural and personal circumstances. Each day, you will help clients navigate challenges, enhance coping mechanisms, and build resilience through customized treatment plans.

Qualifications
  • A Master’s degree in psychology, counseling, social work, or a related field is required.
  • A valid and current state license to practice independently in Vermont, ensuring compliance with local regulations and standards.
  • A minimum of 2 years of formal post-graduate experience in a mental health clinical setting is essential, providing a foundation for effective therapy and care management.
Preferred Experience
  • Experience in telehealth practices is preferred, showcasing your adaptability to virtual platforms and techniques.
  • Prior experience working in an outpatient or community mental health environment is advantageous, enabling you to understand the unique challenges and rewards of this setting.
  • Familiarity with electronic health record (EHR) systems and documentation processes that streamline patient management is viewed favorably.
Compensation and Benefits

We offer a competitive annual salary ranging from $90,000 to $110,000, commensurate with your skills, qualifications, and experience. In addition to a rewarding compensation package, we provide comprehensive benefits, including health insurance, paid time off, and opportunities for professional development and continuing education, fostering your growth as a mental health professional.

Career Growth Opportunities

At InStride Health Associates, we believe in the potential of our employees. As you grow within our organization, you will have access to various training programs, workshops, and mentorship opportunities that will expand your skills and career horizons. There may be pathways for specialization and leadership roles as our practice continues to evolve.

Why Join Our Team

Joining InStride Health Associates means becoming part of a mission-driven team dedicated to making a difference in clients’ lives. You will experience a collaborative atmosphere that values your input, encourages innovation, and emphasizes the importance of mental health in our society. If you are passionate about helping others and want to work in an environment that supports your wellbeing and career aspirations, we invite you to apply!

Application Information

If you are ready to take the next step in your career as a Remote Licensed Clinical Mental Health Counselor with InStride Health Associates, we encourage you to submit your resume and a cover letter detailing your qualifications and interest in the position. We look forward to learning about how you can contribute to our team and our mission!