UM Clinical Reviewer Senior Analyst - Allegiance - Work at Home

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. Core Responsibilities: 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.…