Registered Nurse (RN) — Appeals & Utilization Management

Job overview

The Registered Nurse (RN) — Appeals & Utilization Management role is hybrid in Columbia, SC, with onsite training for at least four weeks before a transition to remote or hybrid work based on competency validation. Compensation is $38 per hour. The clinical review team supports a health insurance organization. The nurse evaluates complex member cases, including appeals and reconsiderations, using clinical judgment and analytical review rather than a simple checklist. The work helps the payer-side team assess cases and meet its review and productivity goals; periodic weekend and holiday on-call coverage is part of the schedule.

What you'll do

• Review and evaluate complex member cases, including appeals and reconsiderations
• assemble and analyze case information
• work independently toward productivity goals
• use Microsoft Office and multiple systems
• assist other departments as needed. Requires an active South Carolina RN license, South Carolina residency, and clinical experience in at least one of critical care, ICU, ER, cardiac PACU, progressive care, or step-down.

What we're looking for

Skills & competencies

registered nurse

appeals

utilization management

columbia sc

hybrid

south carolina residents

$38/hr

clinical review

critical care background

weekend on-call

monday–friday

Work arrangement

• Weekend coverage required

Why this role

Monday–Friday, 8:00 AM–4:30 PM; onsite orientation for at least four weeks; on-call rotation approximately every 4–6 weeks after training, with call typically under six hours per assigned weekend.

About the employer

Talent Software Services, Inc. is hiring for this role. Industry: Direct Health and Medical Insurance Carriers. Sector: 52.