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Cigna Utilization Review Remote Jobs in Washington, DC

Amerihealth Caritas

UM Technician

Washington, DC · On-site +1

$27.02 - $36.78/hr

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet ... Responsibilities: The Utilization Management Technician functions under the direction of the ...

Centerbrite

BCBA (Part-time) (Remote)

Fairfax, VA · Remote

$80 - $110/hr

BCBA (Board Certified Behavior Analyst) - Part-time $80110/hr Flexible Schedule Hybrid (Remote + In ... Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ...

J29 Inc.

Claims Analyst III

Millersville, MD · On-site +1

Remote About J29 J29 is an employee centered healthcare management consulting company that ... Requires 5-7 years work experience (this could be a combination of clinical and utilization review ...

New

McGuireWoods LLP

Director, Benefits

Washington, DC · On-site +1

Along with excellent benefits, McGuireWoods offers most employees a hybrid remote option allowing ... Lead the annual benefits renewal process, including plan design evaluation, utilization review ...

Centerbrite Health

BCBA (Part-time)

Fairfax, VA · On-site +1

$80 - $110/hr

... Hybrid (Remote + In-person) A rare opportunity to join a growing ABA practice as an early team ... Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ...

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Cigna Utilization Review Remote information

See Washington, DC salary details

$17

$36

$60

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 Washington, DC is $36.18, according to ZipRecruiter salary data. Most workers in this role earn between $25.34 and $46.01 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 are popular job titles related to Cigna Utilization Review Remote jobs in Washington, DC?

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

What job categories do people searching Cigna Utilization Review Remote jobs in Washington, DC look for?

The top searched job categories for Cigna Utilization Review Remote jobs in Washington, DC are:

Cigna Utilization Review Remote jobs near you

RN Reviewer/ Workers' Compensation Utilization Review - REMOTE

MICHIGAN PEER REVIEW ORGANIZATION

Washington, DC • Remote

Contractor

Posted 3 days ago

New

Job description

iMPROve Health is seeking an RN Reviewer (Workers' Compensation Utilization Review) to serve as an independent contractor (1099) performing independent external medical reviews remotely on an ad hoc basis.  As a peer reviewer, you will apply your clinical expertise to evaluate cases, specific to your specialty, medical necessity and/or standard of care, supporting efforts to enhance the overall quality and integrity of health care and your profession. Please note, this is not an employed position and our contracted fee is based on credential and specialty type.

BENEFITS:

  • Make a Difference: Use your clinical knowledge to improve the quality of care patients receive.
  • Professional Recognition: Join a network of highly respected experts in your specialty.
  • Competitive Compensation: Receive fair pay for your time and expertise.
  • Protect Standards of Care: Help uphold the integrity of your profession.
  • Work Remotely: Review cases from the convenience of your home or office.
Qualifications

  • Active, unrestricted RN license required; New York RN license strongly preferred.
  • Minimum three (3) years of experience in workers' compensation, utilization review, case management, or occupational health.
  • Working knowledge of Workers' Compensation Medical Treatment Guidelines and evidence-based clinical criteria.
  • Strong clinical assessment, critical thinking, and written communication skills.
  • Experience reviewing medical records and determining medical necessity preferred.

Responsibilities

  • Review treatment requests and medical records for medical necessity and guideline compliance.
  • Apply Workers' Compensation Medical Treatment Guidelines and applicable regulatory requirements.
  • Prepare clear, objective, and timely review determinations.
  • Maintain confidentiality and comply with HIPAA and other applicable privacy requirements.

Technical Requirements

  • Reliable high-speed internet/Wi-Fi connection.
  • Secure home office environment with the ability to protect confidential information.
  • Proficiency using web-based review platforms and Microsoft Office applications.

OTHER REQUIREMENTS:

  • Must complete the electronic credentialing application and receive organizational approval prior to performing a case review.
  • Must complete a conflict of interest attestation upon credentialing and prior to performing a case review.
  • Active hospital medical staff privileges may be required, as applicable.
  • Notify the organization in a timely manner of an adverse change in licensure or certification status, including board certification status.

EOE/VET/Disability