Job Description:
• 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, vision, dental, and well-being and behavioral health programs
• 401(k)
• company paid life insurance
• tuition reimbursement
• a minimum of 18 days of paid time off per year
• paid holidays