Telephonic Registered Nurse Clinical Reviewer - EviCore - Remote

The Cigna Group

Job Overview

Location

United States Work at Home

Job Type

Full-time

Full Job Description

📋 Description

• Perform telephonic clinical reviews to authorize or deny requests for medical services submitted by physician offices and imaging centers, using established clinical protocols and guidelines.
• Evaluate clinical documentation provided by providers to determine if services meet established criteria for coverage, issuing determinations or escalating complex cases to physician reviewers as needed.
• Conduct outbound calls to providers and members to gather additional clinical information, clarify documentation, or provide authorization updates.
• Serve as a resource for members calling with questions about coverage, benefits, or clinical review outcomes, ensuring high-quality customer service.
• Maintain strict adherence to HIPAA and state regulations to protect patient confidentiality and ensure compliance with privacy standards.
• Train in and apply principles of clinical certification, utilization management, URAC, and NCQA standards to all review activities.
• Prepare and distribute program correspondence related to clinical review decisions, authorization outcomes, and member communications.
• Run and analyze operational reports to ensure timely completion of tasks and compliance with regulatory and productivity standards.
• Participate in team meetings, provide peer support through departmental chats and phone consultations, and assist colleagues with clinical or procedural questions.
• Act as a training assistant for new hires when assigned, supporting onboarding and knowledge transfer within the clinical review team.
• Complete all duties within a required shift schedule of Monday–Friday, 12:30 p.m.–9:00 p.m. EST, with potential shift variations after training to any 8-hour window between 7 a.m. local time and 10 p.m. EST.
• Complete a 7-week day-shift training period with no scheduled absences permitted during this phase.
• Demonstrate advanced proficiency in Microsoft Office applications and maintain consistent computer performance throughout the workday.
• Maintain ability to hear and speak clearly on the phone for the full duration of the shift without interruption.
• Work independently with strong self-direction, motivation, and multitasking abilities to meet productivity benchmarks and quality standards.
• Ensure all clinical decisions are made in alignment with EviCore’s policies and regulatory requirements, contributing to accurate and timely utilization management.
• Support departmental projects and operational initiatives as assigned to enhance team efficiency and service delivery.
• Adhere to all internet connectivity requirements: cable broadband or fiber optic service with minimum speeds of 10 Mbps download and 5 Mbps upload for remote work.

🎯 Requirements

• Associates Degree in Nursing required
• Current, unrestricted RN license in state of primary residence
• Minimum 1 year of acute care, managed care, ER, or ICU experience OR 2 years of clinical utilization management experience
• Must be able to work Monday–Friday, 12:30 p.m.–9:00 p.m. EST (training period), with flexibility for future shift changes between 7 a.m. local time and 10 p.m. EST
• Must have reliable high-speed internet (minimum 10 Mbps download / 5 Mbps upload)
• Proficiency in Microsoft Office applications and strong verbal/written communication skills

🏖️ Benefits

• Hourly rate of $31–$52, based on experience and geographic location
• Eligibility for an annual bonus plan
• Medical, dental, and vision coverage starting day one
• Well-being and behavioral health programs
• 401(k) plan with company contributions
• Company-paid life insurance
• Tuition reimbursement
• Minimum 18 days of paid time off per year
• Paid holidays and leaves of absence

Skills & Technologies

Fiber

Remote

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The Cigna Group

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About The Cigna Group

The Cigna Group is a global health services company formed in 1982 through the merger of Connecticut General and INA Corporation. It provides medical, dental, disability, life and accident insurance, pharmacy benefit management, and behavioral health services to employers, individuals and government entities. Headquartered in Bloomfield, Connecticut, the company operates in over 30 countries and jurisdictions, serving more than 180 million customer relationships worldwide through its subsidiaries and affiliates.

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