Coordinator, Managed Care II/CM-DM

TALENT Software Services; Columbia (SC); Hybrid; USD 43,000 - 62,000; Full time

Job summary

TALENT Software Services is seeking a Registered Nurse to join a clinical review team supporting a health insurance client. You will evaluate complex member cases, focusing on appeals and reconsiderations, with a path toward payer-side leadership.

This remote/hybrid role requires SC residency and an active SC RN license. Onsite training is provided, with standard hours and weekend on-call rotation after ramp-up.

Qualifications

• Active, valid South Carolina RN license.
• Must reside in South Carolina.
• Clinical background in critical care, ICU, ER, Cardiac PACU, progressive or step-down units.
• Applicants without a qualifying clinical background will not be considered.

Responsibilities

• Review and evaluate complex member cases, including appeals and reconsiderations.
• Support a health insurance organization on clinical review tasks.
• Operate in a payer-side role with analytical problem solving.

Skills

Analytical skills

Independence

Team flexibility

MS Office

Tools

MS Office

Job description

MAX PAY RATE - $38.00/HR

Title

Registered Nurse - Appeals & Utilization Management

Location

Remote/Hybrid (South Carolina residents only), with onsite training

Employment Type

Contract-to-Hire (not a long-term contract role)

Schedule

Monday-Friday, 8:00 AM - 4:30 PM, plus periodic weekend on-call

Position Overview

We are seeking a Registered Nurse to join a clinical review team supporting a health insurance organization (Client). In this role, you will review and evaluate complex member cases, including appeals and reconsiderations. Each case is a puzzle that requires analytical thinking to put the pieces together, not a simple checklist. This is an excellent opportunity for a clinician with a critical care background who is ready to move into a payer-side role.

Required Qualifications

• Active, valid South Carolina RN license
• Must reside in South Carolina
• Clinical experience in at least one of the following areas:
  • Critical care
  • ICU
  • Emergency Room (ER)
  • Cardiac PACU
  • Progressive care unit
  • Step-down unit

Applicants without one of these clinical backgrounds will not be considered.

Preferred Qualifications

• Appeals and reconsideration experience
• Utilization management experience
• Prior experience working for a health insurance company and/or with the Medicare population

Skills & Attributes

• Strong analytical skills: ability to assemble and evaluate complex case information
• Flexibility and dependability: team members are often called on to assist other departments
• Independence: able to work without constant direction
• Self-driven: motivated to meet productivity goals on your own
• Technical proficiency: knowledge of MS Office (Outlook, Teams, Excel) and the ability to learn and work in multiple systems at the same time

Training/Onboarding

• Training is conducted onsite; expect to be in the office for a minimum of 4 weeks for orientation

Remote/Hybrid Status

• Transition to remote or hybrid work depends on your pace and validation of competency

Schedule

• Regular hours: Monday-Friday, 8:00 AM - 4:30 PM
• On-call: Weekends and holidays are on-call hours (coverage is 7 days a week)
  • Rotation is approximately every 4-6 weeks, once fully trained
  • On-call will not begin for at least 3 months
  • Call is typically less than 6 hours per assigned weekend; exceptions may occur and will be reviewed with management

Interview Process

• Virtual interview via Microsoft Teams with the Program Manager