Cigna Utilization Review Jobs (NOW HIRING)

The Enterprise Clinical team is building a global clinical model that helps The Cigna Group deliver high-quality, safe, and scalable clinical operations. In this hands-on role, you will help launch and grow compliant clinical capabilities across global hubs while protecting patient safety, clinical quality, and regulatory standards. You will partner with Clinical, Enterprise Strategy, Global Talent, Legal, Compliance, HR, Talent Acquisition, and vendor teams to move work from strategy to execution with clarity, care, and speed.

Responsibilities

• Help build and execute the global clinical roadmap, including hub scope, operating model design, workstream plans, milestones, and value tracking.

• Translate wave-based plans into clear action plans that support enterprise goals, clinical guardrails, quality expectations, and regulatory or contract limits.

• Coordinate clinical role assessments by gathering data on clinical complexity, licensure, accreditation, client restrictions, and location readiness.

• Prepare and track submissions through Legal, Regulatory, Compliance, and Global Role Review processes to support sound governance and approval decisions.

• Support transition planning for clinical and clinical-support work, including vendor engagement, hub readiness, credentialing, supervision models, audit checkpoints, and go/no-go materials.

• Partner with HR and Talent Acquisition to support recruiting, credentialing, onboarding, and workforce build plans for clinical and non-clinical hub teams.

• Maintain clear documentation, dashboards, and executive-ready materials that show progress, risks, quality measures, and value delivered.

• Surface risks early, including regulatory, contract, quality, workforce, data privacy, or cost-to-serve concerns, and help leaders make informed trade-off decisions.

• Support change management and stakeholder alignment across Clinical leadership, business teams, Legal, Compliance, Enterprise Strategy, and client-facing partners.

Qualifications

Required Qualifications

• 5+ years of experience in healthcare, clinical operations, transformation, program management, or a related field.

• Experience supporting clinical operations, clinical transitions, global delivery, shared services, GCC, GBS, BPO, captive, or hub-based work.

• Working knowledge of clinical quality, regulatory, licensure, accreditation, data privacy, or compliance requirements.

• Ability to manage multiple workstreams, track milestones, organize complex information, and turn plans into clear actions.

• Strong communication skills with the ability to prepare concise materials for leaders and partner across clinical, legal, compliance, HR, vendor, and enterprise teams.

• Ability to travel, including internationally, up to 20%.

Preferred Qualifications

• Bachelor's degree in healthcare administration, business, nursing, operations, or a related field.

• 8+ years of experience in healthcare, clinical operations, transformation, or delivery.

• Experience helping build or scale clinical hubs in India, the Philippines, or other global talent markets.

• Familiarity with utilization management, case management, pharmacy support, clinical support, or administrative services.

• Experience with clinical workforce economics, including productivity, attrition, time-to-proficiency, quality outcomes, or cost-to-serve measures.

• Experience supporting clinical partnerships, workforce pipelines, credentialing bodies, or academic relationships.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.For this position, we anticipate offering an annual salary of 116,200 - 193,600 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

At The Cigna Group, you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here.

About The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we're dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.