UM Clinical Reviewer Senior Analyst

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.

The UM Clinical Reviewer Senior Analyst promotes quality and cost-effective medical services through clinical review, applying Cigna clinical policies, national guidelines, and decision-support tools to determine authorizations. The role ensures timely completion of reviews to meet regulatory and contractual requirements while representing Cigna professionally.

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.