Utilization Review Nurse — Optimize Care Compliance

Cobalt Benefits Group LLC; Houston (TX); On-site; USD 75,000 - 110,000; Full time

Benefits offered by this job

Medical, dental, and vision insurance

HSA contributions (employer)

Company provided Life and AD&D

Disability insurance

FSA

401(k) with employer match

Paid holidays

Summer Fridays (half day)

Vacation and sick time

Volunteer day

Tuition reimbursement

Wellness reimbursement

Company events

Job summary

Cobalt Benefits Group LLC is seeking a Utilization Review Nurse to review clinical data for medical necessity and cost-effective care under self-funded plans. You will work with intake staff, physicians, and case managers to authorize care and ensure adherence to standards.

Requirements include an active RN license, 3+ years of nursing experience, and 1+ year in UM/UR. MS Office skills and effective communication are essential. Comprehensive benefits and a collaborative team await.

Qualifications

• Current, unrestricted RN license.
• Minimum 3 years of clinical nursing experience.
• Minimum 1 year UM/UR experience.
• Strong analytical and communication skills.
• Proficiency with Microsoft Office and utilization systems.

Responsibilities

• Perform utilization and concurrent reviews using established criteria.
• Review medical necessity and prior authorization requests.
• Gather clinical information and discuss determinations with colleagues.
• Collaborate with Case Managers for interventions.
• Document thoroughly to meet audit standards.
• Participate in team meetings and process improvement.

Skills

RN license

Clinical nursing

UM/UR experience

Analytical thinking

Communication

MS Office

Time management

Tools

Milliman criteria

Aetna criteria

BCBS criteria

Job description

Cobalt Benefits Group LLC is seeking a Utilization Review Nurse to review clinical data for medical necessity and cost-effective care under self-funded plans. You will work with intake staff, physicians, and case managers to authorize care and ensure adherence to standards.

Requirements include an active RN license, 3+ years of nursing experience, and 1+ year in UM/UR. MS Office skills and effective communication are essential. Comprehensive benefits and a collaborative team await.