Nurse Specialist - Registered Nurse

Work at Home, North Carolina, United States (on-site) Schedule Monday-Friday, 9:00 AM - 6:00 PM (local time); includes occasional evenings, holidays, and participation in a 24/7 operation. About the Role We're seeking a Registered Nurse (RN) with strong clinical judgment to join our Utilization Management team. In this role, you'll help ensure members receive appropriate, high-quality, and cost-effective care by reviewing clinical information, making coverage determinations, and collaborating with providers and care teams. What You'll Do Review and assess clinical information using established guidelines and criteria Make coverage determinations across the continuum of care Collaborate with providers and internal partners to coordinate care Identify opportunities to improve care quality and utilization outcomes Refer members to programs and services that support better health outcomes Serve as a clinical resource for internal and external stakeholders Required Qualifications Active, unrestricted RN license in state of residence 3+ years of RN experience 1+ year of Med/Surg experience Proficiency with Microsoft Office (Outlook, Teams, Excel) Associate's degree in nursing (BSN preferred) Preferred Qualifications Utilization Management or Prior Authorization experience Managed care and/or Medicare experience Experience with MedCompass Ambulatory surgery experience This is a great opportunity for an RN looking to leverage clinical expertise in a collaborative, non-bedside role that impacts patient care at scale. Anticipated Weekly Hours: 40 Time Type: Full time Pay Range: $26.01 - $68.55 Benefits: This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr Hispanic Alliance for Career Enhancement