Registered Nurse (RN) - Utilization Management / Case Management (Medicare)

Are you an experienced Registered Nurse (RN) – Utilization Management / Case Management (Medicare) with a desire to excel? If so, then Talent Software Services may have the job for you! Our client is seeking an experienced Registered Nurse (RN) – Utilization Management / Case Management (Medicare) to work at their company in Columbia, SC. Overview : We are hiring for Registered Nurses across multiple Managed Care functions, including Utilization Management (UM) and Case Management (CM/DM), supporting Medicare populations. These roles involve a mix of clinical review, prior authorizations, appeals, and member care coordination in a fast-paced, performance-driven environment. Key Responsibilities: Review medical necessity and process prior authorization requests Perform utilization review and/or appeals handling Manage member cases, including care planning and coordination Support Medicare population with chronic or acute conditions Conduct telephonic case management and patient education Collaborate with providers, care teams, and internal departments Ensure compliance with clinical guidelines and regulatory standards Maintain accurate and detailed clinical documentation Qualifications: Active RN license (South Carolina or compact) 4+ years of recent clinical experience OR utilization management OR case management experience Experience with Medicare or Managed Care environments Strong clinical judgment and analytical skills Excellent written and verbal communication Preferred: Prior Authorization and/or Appeals experience Case Management / Disease Management background Behavioral Health or Adult Care experience Experience working with health insurance providers Work Model & Training On-site training required (1–6 weeks depending on role) Remote/hybrid flexibility available post-training based on performance Must be located in South Carolina (or within 2 hours of Columbia, SC) Compensation & Engagement Contract and Contract-to-Hire opportunities available Equipment provided for remote work Important Considerations Local candidates only (South Carolina) Stable work history required Must have a secure home workspace and reliable high-speed internet