Remote CA RN - Utilization Management & Care Coordination

Cigna Health and Life Insurance Company; California (MO); Hybrid; USD 65,000 - 108,000; Full time

Benefits offered by this job

Health benefits

401(k)

Life insurance

Tuition reimbursement

Paid time off

Holidays

Leaves of absence

Job summary

Cigna Health and Life Insurance Company in California is seeking an Utilization Management Clinical Reviewer to manage an active inpatient caseload from a remote location. You must be an RN licensed in California and available for a Monday–Friday shift 8:00 a.m.–5:00 p.m.

PST. The role involves applying clinical guidelines, coordinating safe transitions across care, collaborating with members, families, providers and internal partners.

Qualifications

• Active, unencumbered California RN licensure.
• Minimum 2 years of direct clinical RN experience in inpatient or managed care.
• Ability to work independently in a remote environment.

Responsibilities

• Manage and coordinate an assigned caseload of complex inpatient cases.
• Complete prospective, concurrent, and retrospective clinical reviews.
• Apply guidelines to evaluate medical necessity, level of care, and discharge needs.
• Document decisions, interventions, and outcomes accurately.
• Coordinate with members, families, providers, facilities, and internal partners.
• Educate members about benefits, care options, and costs.
• Escalate complex cases to appropriate manager or medical director.

Skills

California RN licensure

Inpatient/managed care RN experience

Independent remote work

Strong communication

Organization & critical thinking

Computer/case management systems

Education

Bachelor's degree in nursing

Tools

Computer skills

Clinical/case management software

Job description

Cigna Health and Life Insurance Company in California is seeking an Utilization Management Clinical Reviewer to manage an active inpatient caseload from a remote location. You must be an RN licensed in California and available for a Monday–Friday shift 8:00 a.m.–5:00 p.m.

PST. The role involves applying clinical guidelines, coordinating safe transitions across care, collaborating with members, families, providers and internal partners.