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Full Time Cigna Rn Remote Jobs (NOW HIRING)

Medix

REMOTE LTSS Appeals RN (NY License)

New York, NY · Remote

LTSS Appeals Nurse (Remote) We are seeking a detail-oriented, self-motivated Registered Nurse to join our team as an LTSS Appeals Nurse. In this role, you will perform high-volume clinical reviews ...

New

Cigna

RN Health Coach - Evernorth - Remote

Refer customer to other Cigna Evernorth clinical programs or client specific programs as clinically ... * RN required with active, unrestricted license in respective state, and ability to maintain

Cigna

Home Infusion Nurse - Accredo - Keene, NH

Keene, NH · Remote

$36.75 - $48.50/hr

Home Infusion Registered Nurse - Accredo Specialty Pharmacy Join Accredo Specialty Pharmacy, part ... About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates ...

Cigna

RN Health Coach - Evernorth - Mobile Alabama

Refer customer to other Cigna Evernorth clinical programs or client specific programs as clinically ... * RN required with active, unrestricted license in respective state, and ability to maintain

Fonemed

Telehealth Triage Nurse

Telehealth Triage Nurse (Remote) Full Time 0.8 - 1.0 FTE - Part Time may be considered based on availability Must have compact nursing license Fonemed is recruiting full time remote Registered Nurses ...

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Full Time Cigna Rn Remote information

What is the difference between Full Time Cigna Rn Remote vs Full Time Cigna Lpn Remote?

AspectFull Time Cigna Rn RemoteFull Time Cigna Lpn Remote
Required CredentialsRegistered Nurse (RN) licenseLicensed Practical Nurse (LPN) license
Work EnvironmentRemote, healthcare insurance settingRemote, healthcare insurance setting
Employer & Industry UsageCigna, healthcare insuranceCigna, healthcare insurance
Common Search & ComparisonYesYes

The main difference between Full Time Cigna Rn Remote and Full Time Cigna Lpn Remote lies in the required credentials: RNs need a registered nurse license, while LPNs require a licensed practical nurse license. Both roles typically work remotely within the healthcare insurance industry for Cigna, providing similar services but with different scope of practice and responsibilities based on their licensure.

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For Full Time Cigna Rn Remote jobs, the most frequently searched job titles are:

Full Time Cigna Rn Remote jobs near you

Clinical Review Nurse - Remote

Jacksonville, FL • Remote

ARC Group
11 - 50 employees
Learn more about ARC Groupexternal

Full-time

Re-posted 8 hours ago

Job description

CLINICAL REVIEW NURSE - REMOTE
ARC Group has multiple positions open for Clinical Review Nurses! These positions are 100% remote. These are direct hire FTE positions with salary, benefits, etc. This is a fantastic opportunity to join a dynamic and well-respected organization offering tremendous career growth potential.
At ARC Group, we are committed to fostering a diverse and inclusive workplace where everyone feels valued and respected. We believe that diverse perspectives lead to better innovation and problem-solving. As an organization, we embrace diversity in all its forms and encourage individuals from underrepresented groups to apply.
100% REMOTE!
Candidates must currently have PERMANENT US work authorization. Sorry, but we are not considering any candidates from outside companies for this position (no C2C, 3rd party / brokering).
SUMMARY STATEMENT
The Clinical Review Nurse is responsible for reviewing and making medical determinations as to the validity of health claims and levels of payment in meeting national and local policies as well as accepted medical standards of care. The incumbent applies clinical knowledge to assess the medical necessity, level of services and appropriateness of care which may include cases requiring prior authorization, complex pre-payment medical review or post-payment medical review.
ESSENTIAL DUTIES & RESPONSIBILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary.
90% of time will be spent on one or more of the following activities depending on assignments:
Review and analyze pre and post pay complex health care claims from a medical perspective, inclusive of prior authorization:
  • Perform clinical review work as assigned; may provide guidance to other team members and accurately interpret and apply broad CMS guidelines to specific and highly variable situations.
  • Conduct review of claim data and medical records to make clinical decisions on the coverage, medical necessity, utilization and appropriateness of care per national and local policies, as well as accepted medical standards of care.
  • Review provider practices and identify issues of concern, overpayment and need for corrective action as necessary; includes surfacing potential fraud and abuse or practice concerns.
  • May develop recommendations for further corrective action based on medical review findings.
  • May refer for review, or implement, corrective action related to medical review activities.
  • May process claims and complete project work in the appropriate computer system(s).

The remaining 10% of time will be spent on the following activities depending on assignments:
Identify providers needing education and individually educate providers who are subject to medical
review processes:
  • Initiate or participate in provider teaching activities, creating written teaching material, providing one on one education or education to a group as a result of a medical review (e.g., probe, progressive corrective action, consent, etc.) or appeal.
  • This may involve discussion with CMS leaders and leaders in the provider community.
  • Participate in special projects as assigned.

REQUIRED QUALIFICATIONS
* Valid nursing degree
* 2 years' clinical experience
* Excellent written and oral communication skills
* Demonstrated experience with evaluating medical and health care delivery issues (e.g., Inpatient Rehab Facility)
* Strong computer skills to include Microsoft Office proficiency
* Valid unrestricted Registered Nurse (RN) license
PREFERRED QUALIFICATIONS
* Inpatient Rehabilitation Facility Experience
* Bachelor of Science in Nursing (BSN)
* Insurance industry experience
* Certified Coder
ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed.
At ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know.
Position is offered with no fee to candidate.