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