# Telephonic Registered Nurse Clinical Reviewer – EviCore Remote from[USA](https://jobicy.com/job-region/usa.md)Salary, yearly, USD 62,000 - 104,000Department [Healthcare & Medical](https://jobicy.com/categories/healthcare.md) Employment type Full Time, Job posted6 Jul 2026Apply before6 Aug 2026Experience level Midweight Views / Applies 48 / 2 [About company](https://jobicy.com/company/the-cigna-group.md) * Share About [The Cigna Group](https://jobicy.com/company/the-cigna-group.md) The Cigna Group is a global health company committed to creating a better future built on the vitality of every individual and every community. [Health, Wellness & Fitness](https://jobicy.com/company-category/health-wellness-fitness.md) * 2018 Verified job posting This job post has been [manually reviewed](https://jobicy.com/tools/help-center/employee/how-does-jobicy-verify-the-legitimacy-of-remote-job-listings.md) for authenticity and compliance. ### AI Summary This remote Telephonic Registered Nurse Clinical Reviewer role at EviCore involves evaluating authorization requests for clinical services via phone, fax, or web against established protocols. The position requires an active RN license, at least one year of acute care or managed care experience, and strong communication skills. Responsibilities include making certification decisions, handling member and provider calls, maintaining productivity standards, and ensuring compliance with HIPAA. The shift is Monday-Friday 12:30pm-9:00pm EST, with initial day-shift training. This role offers a comprehensive benefits package and an hourly pay range of $31-$52. ### Role DNA Job Complexity Easy Hard Pace & Pressure Relaxed Fast-paced Autonomy Level Guided Full Ownership Communication Load Independent Highly Collaborative AI Insight The role requires clinical judgment, multitasking, and adherence to protocols, but decisions are guided by established criteria and physician referral for complex cases, making it moderately challenging. ### Salary Analysis Median Market Rate USD83,000US Market USD60k – 120k 0 USD132k AI Insight The offered salary range of $62,000-$104,000 per year is competitive for a telephonic nurse reviewer role, with the median of $83,000 aligning well with market rates. The position also includes eligibility for an annual bonus and comprehensive benefits. ### Core Skills Required [Clinical Review](https://jobicy.com/jobs?search_keywords=Clinical+Review.md) [Utilization Management](https://jobicy.com/jobs?search_keywords=Utilization+Management.md) [RN License](https://jobicy.com/jobs?search_keywords=RN+License.md) [Telephonic Triage](https://jobicy.com/jobs?search_keywords=Telephonic+Triage.md) [Customer Service](https://jobicy.com/jobs?search_keywords=Customer+Service.md) [Data Analysis](https://jobicy.com/jobs?search_keywords=Data+Analysis.md) [HIPAA Compliance](https://jobicy.com/jobs?search_keywords=HIPAA+Compliance.md) [Care Coordination](https://jobicy.com/jobs?search_keywords=Care+Coordination.md) [Critical Thinking](https://jobicy.com/jobs?search_keywords=Critical+Thinking.md) [MS Office](https://jobicy.com/jobs?search_keywords=MS+Office.md) ### Cover Letter Sample I am writing to express my interest in the Telephonic Registered Nurse Clinical Reviewer position at EviCore. With my active RN license and over two years of acute care and utilization management experience, I am confident in my ability to evaluate clinical requests effectively against set protocols. In my previous role, I handled high-volume calls, performed clinical reviews, and ensured compliance with regulatory standards, which aligns perfectly with this position's requirements. I am skilled in multitasking, maintaining productivity, and providing exceptional customer service. I am particularly drawn to EviCore's focus on supporting whole health and the opportunity to contribute to a team that values clinical expertise and collaboration. I look forward to the possibility of discussing how my background can benefit your organization. Copy ### Sample Interview Questions Can you describe your experience with utilization management and how you apply clinical criteria to make authorization decisions?In my previous role, I used InterQual and MCG criteria daily to review authorization requests. I would assess the clinical information provided, compare it to the criteria, and either approve, modify, or refer to a physician reviewer if criteria were not met. I ensured decisions were consistent and well-documented.How do you handle a situation where a provider disagrees with your certification decision?I would first listen to the provider's concerns and review the case details again. If needed, I would explain the rationale based on the established criteria. If the provider still disagrees, I would follow the escalation process, which may involve referring to a physician reviewer or initiating an appeal. Maintaining professionalism and empathy is key.This role requires working a fixed shift from 12:30pm to 9pm EST. How do you manage your time and maintain focus during later hours?I maintain a consistent routine, ensuring I get adequate rest and take breaks as scheduled. I use time management strategies like prioritizing tasks and minimizing distractions. I also stay engaged by varying my tasks between calls, reviews, and documentation.Describe a time when you had to multitask under pressure. How did you prioritize?During a high-volume call period, I had to simultaneously handle incoming calls, review web requests, and keep up with documentation. I prioritized by addressing urgent clinical cases first, using quick decision-making based on protocols, and organizing my workflow to ensure all tasks were completed within productivity standards.How do you ensure compliance with HIPAA and other regulations when handling patient information over the phone?I always verify the identity of the caller and only discuss necessary information. I avoid sharing details in public areas and use secure systems. I also stay updated on privacy training and adhere to company policies, reporting any potential breaches immediately. Telephonic Nurse Clinical Reviewer -EviCore-Remote Full time RN Role- Remote Monday- Friday 12:30pm-9:00 pm EST (Required Shift) Start Date: Monday, September 14th Shift for this role is Monday- Friday 12:30pm-9:00 pm EST. Start time may vary based on your local time zone. The first 7 weeks of employment will be day shift for training purposes. In the future, shift may vary based on business need to any 8 hour shift between the hours of 7am in your local time zone – 10 pm EST, Monday – Friday. There are no scheduled absences allowed during training for this role. The Clinical Reviewer will be responsible for: * All clinical certification activities, which include but are not limited to evaluating telephone, fax or WEB requests for authorization of clinical services from physician offices/and or imaging centers, comparing requests against established clinical protocols and authorizing services or referring requests for expert clinical review as appropriate. * Know and understand complex case specialties and case reviews. * Review clinical information submitted by providers to appropriate criteria and standards and makes decision to issue a review determination or to refer to physician review if criteria are not met. * Maintain current departmental standards related to productivity. * Train in clinical certification, utilization management, URAC and NCQA principles, policies, and procedures. * Prepare program correspondence as needed. * Serve as a resource for members calling for assistance. * Make outbound calls as required. * Refer provider and member complaints, and appeals to appropriate departments. * Maintain patient confidentiality in accordance with EviCore standards established in compliance with HIPAA and State regulations. * Provide outstanding customer service ensuring callers receive the highest possible service. * Run and analyze reports to ensure all tasks are completed in a timely fashion and meet regulatory requirements. * Assist team members in departmental chats, by phone and in person. * Act as training assistant when assigned. * Assist team members with questions, participates in team meetings. Can be assigned to projects to support the department as needed. * Performs related duties as required. Essential Functions: * Must be able to sit through shift, demonstrate advanced proficiency in MS Office applications. * Excellent communication skills both verbal and written; * Excellent problem solving and customer service skills are required. * Must be self-directed and highly motivated with an ability to multi-task. * Excellent computer skills. * Must be able to hear and speak on the phone for an entire shift Qualifications: * Associates Degree in Nursing required. * Current, unrestricted license as an RN in state of primary residence * Must have at least 1 year of acute care, managed care, ER, ICU experience or 2 years of clinical utilization management experience If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an hourly rate of 31 – 52 USD / hourly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, [click here](https://jobs.thecignagroup.com/us/en/benefits). About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you need a reasonable accommodation to complete the online application process, please email [seeyourself@thecignagroup.com](mailto:seeyourself@thecignagroup.com) for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances. Show more [Apply now >](https://jobicy.com/jobs/148821-telephonic-registered-nurse-clinical-reviewer-evicore.md) * ![Upload CV](data:image/svg+xml;base64,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) ### Upload your resume now To unlock remote work opportunities and be discovered by global employers. 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