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Cigna Utilization Review Remote Jobs in Rosharon, TX

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$13

$28

$47

How much do cigna utilization review remote jobs pay per hour?

As of Sep 5, 2026, the average hourly pay for cigna utilization review remote in Rosharon, TX is $28.58, according to ZipRecruiter salary data. Most workers in this role earn between $20.00 and $36.35 per hour, depending on experience, location, and employer.

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 job categories do people searching Cigna Utilization Review Remote jobs in Rosharon, TX look for?

The top searched job categories for Cigna Utilization Review Remote jobs in Rosharon, TX are:

What cities near Rosharon, TX are hiring for Cigna Utilization Review Remote jobs?

Cities near Rosharon, TX 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 Rosharon, TX as of August 2026, with employment types broken down into 86% Full Time, and 14% Contract. Highlights an 100% Remote job distribution, with an average salary of $59,445 per year, or $28.6 per hour.

Clinical Admin Coordinator

Allmed Staffing Inc

Pearland, TX • Remote

$13.50/hr

Full-time

Medical, Dental, Vision, Retirement

Posted 10 days ago

Job description

Referral Navigator Representative

Job Type: Full-Time / Remote
Work Location: Remote
Schedule: 8:00 AM–7:00 PM scheduling window; specific shift assigned based on business needs
Contract: 08/17/2026 to 12/31/2026
Pay Rate: $13.50/hr (Paid Weekly)
Allmed Benefits: Vision, Health, Dental Insurance and 401(k)
Interview Process: One video interview

Position Overview

We are seeking a Referral Navigator Representative to support authorization and referral operations in a remote healthcare environment. This position is responsible for coordinating fax-based documentation and supporting the authorization process to ensure referrals and prior authorization requests are processed accurately, efficiently, and within established timelines.

The ideal candidate will have experience in healthcare administration, prior authorizations, referrals, or health plan operations, with a strong understanding of payer requirements and healthcare workflows.

Key Responsibilities

  • Coordinate incoming and outgoing faxes related to referrals and prior authorizations.
  • Review referral and authorization documentation for completeness and accuracy.
  • Process and route documentation to the appropriate departments, providers, or health plan representatives.
  • Track authorization and referral requests and follow up on outstanding documentation.
  • Work with provider offices, insurance plans, and internal teams to obtain required information.
  • Ensure requests are processed according to established payer guidelines and turnaround times.
  • Maintain accurate records and documentation within applicable systems.
  • Identify missing or incomplete information and take appropriate action to resolve issues.
  • Protect confidential patient information and maintain compliance with HIPAA and applicable healthcare regulations.
  • Support utilization management and authorization workflows as assigned.

Required Qualifications

  • 2–4+ years of experience in prior authorization processing, referral coordination, healthcare administration, or healthcare operations.
  • Knowledge of insurance plans, payer guidelines, and authorization requirements.
  • Understanding of basic medical terminology.
  • Strong attention to detail and organizational skills.
  • Excellent written and verbal communication skills.
  • Ability to manage multiple tasks and prioritize work in a fast-paced environment.
  • Strong computer skills and ability to navigate multiple systems.
  • Ability to work independently in a remote environment.

Preferred Qualifications

  • Experience working with managed care organizations, health plans, or provider offices.
  • Familiarity with utilization management workflows.
  • Experience with compliance standards and audit processes.
  • Previous experience coordinating referrals and authorizations through fax-based workflows.

Apply