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Entry Level Cigna Utilization Review Nurse Jobs (NOW HIRING)

Virginia Mason Medical Center

$52.03 - $101.24/hr

Job Summary and Responsibilities As our Utilization Review Nurse, you will ensure the medical necessity and appropriateness of care for all hospitalized patients, promoting fiscal responsibility and ...

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Oscar Health

Utilization Review Nurse

Dallas, TX · 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 ...

Oscar Health

Utilization Review Nurse

Miami, FL · 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 ...

Oscar Health

Utilization Review Nurse

Atlanta, GA · 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 ...

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 ...

Miami Jewish Health

Utilization Review Nurse

Miami, FL · On-site

Utilization Review Nurse Job Summary The Utilization Nurse is responsible for conducting prospective, concurrent, and retrospective clinical reviews to determine medical necessity, level of care, and ...

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Entry Level Cigna Utilization Review Nurse information

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

As of Jul 30, 2026, the average hourly pay for entry level 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 the difference between Entry Level Cigna Utilization Review Nurse vs Entry Level Case Manager?

AspectEntry Level Cigna Utilization Review NurseEntry Level Case Manager
CertificationsRN license, possibly AHC or Cigna-specific trainingRN license, case management certification (e.g., CCM)
Work EnvironmentInsurance company, healthcare setting, review teamsHealthcare facilities, community agencies, insurance companies
Job FocusReview medical necessity, approve or deny coverageCoordinate patient care, arrange services, support patient needs
Common UsageUsed in health insurance, utilization managementUsed in patient advocacy, care coordination

While both roles require healthcare knowledge and RN licensure, the Entry Level Cigna Utilization Review Nurse primarily focuses on reviewing medical necessity for insurance coverage, whereas the Entry Level Case Manager concentrates on coordinating patient care and services. Understanding these differences helps job seekers identify the right role based on their skills and career goals.

What are some common challenges faced by Entry Level Utilization Review Nurses at Cigna, and how can they be addressed?

Entry Level Utilization Review Nurses at Cigna often encounter challenges such as managing high caseloads, staying up-to-date with evolving healthcare guidelines, and balancing administrative tasks with patient advocacy. Successfully navigating these challenges involves strong organizational skills, effective communication with multidisciplinary teams, and continuous learning through Cigna’s training programs. Building relationships with more experienced colleagues can provide valuable mentorship and support as you grow in the role.

What does an Entry Level Cigna Utilization Review Nurse do?

An Entry Level Cigna Utilization Review Nurse is responsible for reviewing patient medical records to determine the medical necessity and appropriateness of healthcare services and procedures. They work with physicians, healthcare providers, and insurance teams to ensure that patients receive proper care while managing healthcare costs. This role involves assessing clinical information, applying Cigna’s guidelines, and communicating decisions to patients and providers. Entry level nurses in this position typically receive training in Cigna’s protocols and may work under the supervision of more experienced nurses.

What are the key skills and qualifications needed to thrive as an Entry Level Cigna Utilization Review Nurse, and why are they important?

To thrive as an Entry Level Cigna Utilization Review Nurse, you need a registered nursing license, clinical knowledge, and an understanding of healthcare regulations and medical necessity criteria. Familiarity with utilization management software, electronic health records (EHRs), and insurance review systems is typically required. Strong analytical thinking, attention to detail, and effective communication skills help nurses collaborate with providers and advocate for patients. These skills ensure accurate assessments, regulatory compliance, and quality patient outcomes within the managed care environment.
What cities are hiring for Entry Level Cigna Utilization Review Nurse jobs? Cities with the most Entry Level Cigna Utilization Review Nurse job openings:
What are the most commonly searched types of Cigna Utilization Review Nurse jobs? The most popular types of Cigna Utilization Review Nurse jobs are:
What states have the most Entry Level Cigna Utilization Review Nurse jobs? States with the most job openings for Entry Level Cigna Utilization Review Nurse jobs include:
Entry Level Cigna Utilization Review Nurse jobs near you

Utilization Review Nurse

Health Business Solutions LLC

Cooper City, FL

Full-time

Posted 21 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.

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