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Contractual Cigna Utilization Review Nurse Jobs (NOW HIRING)

Fusion HCR

Utilization Review Nurse

Las Vegas, NV · On-site

Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in Acute Care. Overview Seeking an experienced Utilization Review Nurse (RN) to review patient admissions ...

Acrisure LLC

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

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

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 ...

Global Force

Utilization Review Nurse

Las Vegas, NV · On-site

About the job Utilization Review Nurse Sign on bonus may apply up to $15,000 Position Summary: Reviews patient admissions for appropriateness, efficiency of resource utilization and compliance with ...

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You will perform frequent case reviews, check medical records and speak with care providers regarding ...

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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 1, 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.

What cities are hiring for Contractual Cigna Utilization Review Nurse jobs?

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What are the most commonly searched types of Cigna Utilization Review Nurse jobs?

The most popular types of Cigna Utilization Review Nurse jobs are:

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Contractual Cigna Utilization Review Nurse jobs near you

Utilization Review Nurse

Fusion HCR

Las Vegas, NV • On-site

Other

This job post has expired today. Applications are no longer accepted.

Job description

Fusion HCR is hiring!Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in Acute Care.
Overview
Seeking an experienced Utilization Review Nurse (RN) to review patient admissions for medical necessity, appropriate level of care, and compliance with payer guidelines. This role works closely with clinical teams to ensure efficient resource utilization and quality patient outcomes.
Responsibilities
  • Review admissions using InterQual and/or Milliman criteria
  • Evaluate medical necessity, level of care, and documentation accuracy
  • Ensure compliance with Medicare, Medicaid, and regulatory guidelines
  • Collaborate with physicians, case management, and care teams
  • Support discharge planning and care coordination
  • Document findings and communicate recommendations

Requirements
  • Active RN license (Nevada)
  • 5+ years acute care nursing experience
  • 3+ years Utilization Review experience
  • 3+ years discharge planning experience (acute care)
  • Experience with InterQual (must be able to pass exam)
  • Experience with Milliman guidelines

Preferred
  • Background in Case Management or CDI
  • Strong knowledge of Joint Commission and CMS guidelines

Why Apply
  • Competitive pay
  • Stable, high-demand role
  • Collaborative healthcare environment

Apply Now
If you have strong Utilization Review, InterQual, and acute care experience, we want to hear from you!

Apply