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Contractual Cigna Utilization Review Nurse Jobs (NOW HIRING)

Sentara Health Plans

$65 - $85/hr

The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical ...

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines ...

Acrisure, LLC

Utilization Review Nurse

Bradenton, FL · On-site

$55 - $90/hr

Utilization Review Nurse, LPN** to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines and regulatory ...

Acrisure, LLC

$55 - $90/hr

Utilization Review Nurse, LPN** to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines and regulatory ...

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines ...

AbsoluteCare

Utilization Review Nurse

New Orleans, LA · On-site

The Utilization Review Nurse ensures appropriate utilization of health services by performing initial, concurrent and retrospective clinical case reviews. This role collaborates and communicates with ...

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Contractual Cigna Utilization Review Nurse information

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How much do contractual cigna utilization review nurse jobs pay per hour?

As of Sep 6, 2026, the average hourly pay for contractual cigna utilization review nurse in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

What is a Contractual Cigna Utilization Review nurse?

Contractual Cigna Utilization Review Nurses are registered nurses employed on a contract basis to perform utilization review for Cigna, a major health insurance company. Their primary role is to assess the medical necessity, appropriateness, and efficiency of healthcare services requested for patients. They review medical records, communicate with providers, and ensure that care aligns with Cigna’s guidelines and policies. This helps manage healthcare costs while ensuring patients receive appropriate care. These nurses often work remotely and collaborate with a multidisciplinary team.

What are the key skills and qualifications needed to thrive as a Contractual Cigna Utilization Review nurse?

To excel as a Contractual Cigna Utilization Review Nurse, you need a current RN license, strong clinical assessment abilities, and a solid understanding of insurance guidelines and medical necessity criteria. Familiarity with utilization management software, electronic medical records (EMR), and industry certifications like CCM or URAC accreditation is often required. Exceptional attention to detail, critical thinking, and effective communication help in reviewing cases and collaborating with healthcare providers. These skills ensure accurate evaluations, regulatory compliance, and optimal patient outcomes while managing healthcare costs.

How does a Contractual Cigna Utilization Review nurse typically collaborate with physicians and other healthcare providers to ensure appropriate care decisions?

As a Contractual Cigna Utilization Review Nurse, you are responsible for collaborating closely with physicians, case managers, and other healthcare professionals to review patient cases and ensure that care decisions meet both clinical guidelines and insurance requirements. This collaboration often involves discussing treatment plans, clarifying medical necessity, and providing evidence-based recommendations. Effective communication and negotiation skills are essential, as you may need to advocate for patients while upholding Cigna’s policies. Most interactions occur via phone calls, secure emails, or electronic health record systems, and teamwork is key to timely and accurate case resolutions.

What is the difference between Contractual Cigna Utilization Review Nurse vs Insurance Claims Reviewer?

AspectContractual Cigna Utilization Review NurseInsurance Claims Reviewer
CredentialsRN license, certification in utilization reviewTypically claims processing certification or related experience
Work EnvironmentHealthcare settings, insurance companies, remote optionsInsurance companies, claims processing centers, remote work
Employer & IndustryHealth insurance providers, healthcare industryInsurance carriers, third-party claims companies
Primary FocusAssess medical necessity, approve or deny servicesReview claims for accuracy, coverage, and payment

The Contractual Cigna Utilization Review Nurse primarily evaluates medical necessity for insurance claims, ensuring appropriate care. In contrast, the Insurance Claims Reviewer focuses on processing and verifying claims for coverage and payment accuracy. Both roles require attention to detail and familiarity with insurance policies, but they serve different stages in the claims process.

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Contractual Cigna Utilization Review Nurse jobs near you

Utilization Review Nurse

Health Business Solutions LLC

Cooper City, FL • On-site

Full-time

Re-posted 29 days ago

Job description

Job Summary: We are seeking a highly motivated and experienced Utilization Review Nurse to join our team. The Utilization Review Nurse will play a crucial role in supporting our clients in the healthcare industry by providing expert clinical guidance, facilitating effective utilization management, and ensuring revenue cycle efficiency. This position offers a unique opportunity to combine clinical expertise with revenue cycle management knowledge.

Key Responsibilities:

·       Clinical Assessment: Conduct comprehensive clinical assessments of medical records to ensure patients are receiving appropriate care at the correct level of service.

  • Care Coordination: Collaborate with interdisciplinary healthcare teams to coordinate patient care and treatment plans, ensuring the most cost-effective and clinically appropriate care is provided.
  • Revenue Cycle Management: Utilize clinical expertise to support revenue cycle processes, including accurate coding, documentation improvement, and compliance with healthcare regulations.
  • Utilization Review:

a) Apply medical necessity screening criteria and clinical knowledge to ensure appropriateness of admissions and length of stays

b) Conduct initial admission, continuing stay, and 23-hour observations reviews for all patients

c) Support Utilization Review Coordinator team members on cases escalated for level of care determinations

d) Screen cases for Physician Advisor review

e) Collaborate with insurance companies on concurrently denied and high risk for denial cases

  •  Documentation Improvement: Identify opportunities for improving clinical documentation to support accurate coding and billing processes, ultimately improving reimbursement.


  • Data Analysis: Analyze clinical and financial data to identify trends, opportunities for improvement, and areas of potential cost savings for clients.


  • Compliance: Stay up-to-date with healthcare regulations, guidelines, and policies to ensure all patient care and revenue cycle processes are in compliance with industry standards and regulatory requirements to ensure appropriate reimbursement.

Qualifications:

·       Registered Nurse (RN) licensure required; must hold a USRN multi-state/compact nursing license.

·       Bachelor of Science in Nursing (BSN) preferred.

·       Case Management Certification (e.g., CCM) is a plus.

·       Minimum of 3 years of clinical nursing experience, preferably in a hospital or acute care setting.

·       Minimum 2 years of work experience in Utilization Review

·       Strong understanding of revenue cycle management and healthcare reimbursement.

·       Proficiency in medical coding and clinical documentation improvement.

·       Excellent communication, interpersonal, and teamwork skills.

·       Ability to work independently and make sound clinical and financial decisions.

·       Strong analytical and problem-solving skills.

·       Proficient in using healthcare information systems and technology.

·       Commitment to maintaining patient confidentiality and ethical standards.