Remote RN: Appeals & Utilization Management

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

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.