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Manager Cigna Rn Remote Jobs in Maryland (NOW HIRING)

CareFirst

Care Manager - RN (Remote)

Baltimore, MD · Remote

This RN position supports line of business. Under minimal supervision, the Care Manager researches and analyzes members' medical and behavioral health needs and healthcare cost drivers. The Care ...

CareFirst

Care Manager (Remote)

Baltimore, MD · Remote

CCM/ACM or other RN Board Certified certification in case management. * Previous experience with Medicare and/or Medicare Advantage patient populations with multiple co-morbidities, complex needs ...

Avail Health

RN Care Manager, Care Transitions

Rockville, MD · On-site +1

$94K - $115K/yr

The RN Care Manager leads the medical track of that program - serving as the primary clinical point ... Hybrid - primarily remote with in-person visits when clinically indicated Schedule: Monday-Friday ...

Cinqcare

Registered Nurse

Laurel, MD · Remote

Overview The RN reports to the Clinical Manager or designee, with accountability for providing ... Deploys Remote Patient Monitoring and Patient Self Reporting for High-Risk Chronic Conditions.

Cinqcare

Registered Nurse

Laurel, MD · Remote

Overview The RN reports to the Clinical Manager or designee, with accountability for providing ... Deploys Remote Patient Monitoring and Patient Self Reporting for High-Risk Chronic Conditions.

Cinqcare

Registered Nurse

Laurel, MD · Remote

Overview The RN reports to the Clinical Manager or designee, with accountability for providing ... Deploys Remote Patient Monitoring and Patient Self Reporting for High-Risk Chronic Conditions.

Cinqcare

Registered Nurse

Laurel, MD · Remote

Overview The RN reports to the Clinical Manager or designee, with accountability for providing ... Deploys Remote Patient Monitoring and Patient Self Reporting for High-Risk Chronic Conditions.

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Manager Cigna Rn Remote information

What is the difference between Manager Cigna Rn Remote vs Cigna Rn Case Manager?

AspectManager Cigna Rn RemoteCigna Rn Case Manager
CertificationsRN license, management experienceRN license, case management certification often preferred
Work EnvironmentRemote management, team oversightRemote or in-office, direct patient or provider interaction
Employer & IndustryHealth insurance, managed careHealth insurance, case management services

The Manager Cigna Rn Remote typically oversees teams and operations within Cigna's health insurance services, requiring management skills and RN licensure. In contrast, the Cigna Rn Case Manager focuses on direct patient or provider interactions, coordinating care plans. Both roles are remote and within the same industry but differ in responsibilities and focus areas.

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Manager Cigna Rn Remote jobs near you
Utilization Management RN (Remote) | Baltimore, MD |

Utilization Management RN (Remote) | Baltimore, MD |

Morgan Stephens

Baltimore, MD • Remote

Other

Retirement, PTO

Posted 9 days ago

Job description

Job Title: Utilization Management RN (Remote) | Baltimore, MD | $85K+

Fully remote opportunity
Fast interview process

Location: Baltimore, MD (Remote - must reside in Maryland or hold compact license)
Job Type: Full-Time
Department: Utilization Management

About Us
Morgan Stephens represents the nation's top healthcare systems, offering highly competitive compensation and benefits to top candidates. We are led by experienced healthcare industry professionals and specialize in contract, contract-to-hire, and direct placement services nationwide.

We have successfully placed thousands of healthcare professionals into organizations seeking high-quality talent and continue to partner with leading health systems and managed care organizations.

Position Summary
The Utilization Management RN plays a critical role in ensuring healthcare services are delivered with quality, cost efficiency, and full regulatory compliance. Through ongoing review and audit of clinical documentation, this role helps prevent unnecessary procedures, ineffective treatment, and extended hospital stays.

This position is ideal for an RN with strong clinical judgment, prior authorization experience, and a background in managed care, hospital case management, or utilization review.

Job Duties and Responsibilities

Perform concurrent review of patient clinical information for medical necessity and efficiency

Conduct ongoing review of precertification and prior authorization requests

Ensure services align with established clinical guidelines (MCG or InterQual)

Monitor the activities of clinical and non-clinical staff related to utilization processes

Coordinate discharge planning needs with the interdisciplinary healthcare team

Advocate for quality care and improved patient outcomes

Identify opportunities to reduce unnecessary hospital stays and prevent complications

Maintain accurate and timely documentation of all patient-related interactions

Prepare reports on patient management, utilization trends, and cost savings

Provide daily updates to the Manager of Utilization Management

Work effectively in a fast-paced, high-volume environment with minimal supervision

Skills and Qualifications

Active, unrestricted Registered Nurse (RN) license in Maryland or compact state (required)

Bachelor's degree in Nursing (BSN preferred)

Minimum of 2+ years of experience in Utilization Management or Case Management

Strong knowledge of MCG or InterQual guidelines

Experience with prior authorizations, concurrent review, and medical necessity determinations

Proficiency in EMR systems and Microsoft Office (Excel, Word, Outlook)

Strong critical thinking, organizational, and communication skills

Ability to work independently in a fully remote environment

Preferred Experience

Managed care or health plan experience (Medicaid or Medicare populations preferred)

Experience with Maryland Medicaid or long-term services and supports (LTSS)

Utilization Management (UM) or Case Management certification (CCM, ACM) preferred

Why This Role Matters
This role directly impacts patient outcomes, cost efficiency, and quality of care. You will play a key role in ensuring patients receive appropriate, timely, and effective treatment while supporting the overall healthcare system.

Benefits Include
Competitive compensation, full benefits package, 401(k) with match, paid time off, continuing education support, and full remote flexibility.

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