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Telephonic Registered Nurse Clinical Reviewer - EviCore
The Cigna Group is seeking a remote, full-time Telephonic Registered Nurse Clinical Reviewer to manage clinical certification activities and utilization management for EviCore.
Job Description
Role Overview
- Employer: The Cigna Group
- Location: Remote
- Schedule: Monday - Friday, 12:30 pm - 9:00 pm EST (Initial training on day shift)
Responsibilities
- Evaluate telephone, fax, or web requests for authorization of clinical services.
- Compare requests against established clinical protocols and authorize services or refer for expert review.
- Maintain departmental productivity and compliance standards (URAC, NCQA, HIPAA).
- Provide customer service to members and providers via inbound and outbound calls.
Qualifications
- Active and unrestricted RN license in the state of primary residence.
- Associate Degree in Nursing (ADN).
- Minimum of 1 year of acute care, managed care, ER, or ICU experience, or 2 years of clinical utilization management experience.
- Advanced proficiency in MS Office and strong computer skills.
Requirements & Skills
Specialty
Utilization Management
Education
Associate
Experience
1+ year
Licenses
RN
Skills
Telephonic ReviewUtilization ManagementClinical ReviewCustomer ServiceHIPAA ComplianceURACNCQA