Senior UM Nurse – Remote Medical Necessity & Compliance

TALENT Software Services is seeking a Senior Utilization Management Nurse in California to review post-service claims for medical necessity and evaluation against contract language. The role requires strong clinical judgment and in-depth knowledge of UM processes, DRG validation, and hospital billing standards.

You will audit line-by-line itemizations, collaborate with Medical Directors, and communicate decisions to providers and members while ensuring compliance with state and accreditation

We are seeking a motivated Senior UM Nurse – Remote Medical Necessity & Compliance to join TALENT Software Services in Rancho Cordova, CA, United States.

As a Senior UM Nurse – Remote Medical Necessity & Compliance, you will play an important part at TALENT Software Services in Rancho Cordova, CA, United States.

We invite applications for the Senior UM Nurse – Remote Medical Necessity & Compliance position located in Rancho Cordova, CA, United States.