Senior Clinical Reviewer Analyst

Role Overview

• Conduct utilization management reviews for medical necessity, appropriateness, and benefit coverage
• Apply Cigna medical policies, MCG, ASAM, URAC standards, and clinical judgment
• Identify cases requiring physician review and coordinate with Medical Directors
• Initiate Case Management referrals as appropriate
• Maintain compliance with HIPAA, regulatory rules, and internal quality standards
• Participate in team meetings, quality audits, training, and workflow improvements
• Support departmental initiatives, documentation accuracy, and performance metrics

Requirements

• Registered Nurse (RN) with multistate license in good standing
• BSN preferred; Minimum 3 years RN experience in managed care, UM, or prior authorization
• Strong analytical, communication, and decision-making skills
• Proficiency with Windows, Word, care management platforms, and documentation systems
• Ability to manage multiple tasks, meet deadlines, and adapt to a fast-paced environment

Benefits

• Medical insurance
• Vision insurance
• Dental insurance
• Behavioral health programs
• 401(k)
• Company paid life insurance
• Tuition reimbursement
• Minimum of 18 days of paid time off per year
• Paid holidays