Utilization Review Nurse
Cigna - Birmingham, AL

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Job Description Determines whether services provided to plan members were actually medically necessary. Develops and maintains knowledge of provider organization review procedures. Maintains reporting system for Utilization Review. Requires a RN with typically three years of clinical experience.

. Requirements RN, active RN license without restrictions, as well as previous clinical experience (at least 2 years); experience with performance of medical review activities; utilize established criteria and guidelines in making clinical decisions; excellent oral/written communication skills; decision making and organizational skills are a must. Results-oriented with proven ability to meet multiple deadlines while insuring quality work.

Familiar with ICD/CPT coding; Claims appeal experience; QNXT/CCMS system familiarity; appeals experience; knowledge of Medicare policies and guidelines; knowledge of Medicaid (State of IL) processes and requirements, including Medicaid waiver program.


CIGNA - 11 months ago - save job - block
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With a significant position in the US health insurance market, CIGNA covers some 11.5 million Americans with its various medical plans. The...