Cognizant
Clinical Registered Nurse - Utilization Management - Remote
Cognizant, Hatboro, Pennsylvania, United States
Clinical Registered Nurse – Utilization Management – Remote
Join to apply for the
Clinical Registered Nurse – Utilization Management – Remote
role at
Cognizant .
Schedule:
Monday to Friday – Eastern Time
Location:
Remote
About The Role As a Registered Nurse you will make an impact by performing advanced level work related to clinical denial management and managing clinical denials from Providers to the Health Plan/Payer. The process includes analyzing, reviewing, and processing medical necessity denials for resolution. You will be a valued member of the Cognizant team and work collaboratively with stakeholders and other teams.
In This Role, You Will
Maintain ownership and responsibility for assigned accounts.
Maintain working knowledge of applicable health insurers’ internal claims, appeals, and retro‑authorization as well as timely filing deadlines and processes.
Review clinical denials including but not limited to referral, preauthorization, medical necessity, non‑covered services, investigational/experimental and billing resulting in denials and/or delays in payment.
Draft and submit the medical necessity determinations to the Health Plan/Medical Director based on the review of clinical documentation in accordance with Medicare, Medicaid, and third‑party guidelines.
Effectively document and log claims/appeals information on relevant tracking systems.
Utilize critical thinking skills to interpret guidelines of internal policies for clinical determination.
Medical necessity reviews can be based on InterQual, Milliman Clinical Guidelines (MCG), Medicare guidelines, and health insurer specific guidelines.
Review retro‑authorizations in accordance with health insurer requirements and follow insurer process guidelines.
Identify denial patterns with clients to mitigate risk and minimize regulatory penalties.
Escalate potential risks to client, client partners and/or leadership.
Demonstrate critical thinking skills to interpret guidelines of internal policies for clinical determination.
We strive to provide flexibility wherever possible. This is a remote position open to qualified applicants in the United States, and we support a healthy work‑life balance through wellbeing programs.
What You Need To Have To Be Considered
Educational background – Registered Nurse (RN)
2‑3 years combined clinical and/or utilization management experience with a managed health care plan
3 years’ experience in health care revenue cycle or clinic operations
Experience in utilization management including Clinical Appeals and Grievances, precertification, initial and concurrent reviews
Intermediate Microsoft Office knowledge (Excel, Word, Outlook)
In‑patient and outpatient experience
These will help you stand out
Epic experience
Experience in drafting appeals disputing inpatient clinical validations audits is a plus.
We’re excited to meet people who share our mission and can make an impact in a variety of ways. Don’t hesitate to apply, even if you only meet the minimum requirements listed. Think about your transferable experiences and unique skills that make you stand out.
Salary and Other Compensation Applications will be accepted until Jan 9, 2026.
The annual salary for this position is between
$70,000 – $74,000
depending on experience and other qualifications of the successful candidate.
This position is also eligible for Cognizant’s discretionary annual incentive program and stock awards, based on performance and subject to the terms of Cognizant’s applicable plans.
Benefits
Medical/Dental/Vision/Life Insurance
Paid holidays plus Paid Time Off
401(k) plan and contributions
Long‑term/Short‑term Disability
Paid Parental Leave
Employee Stock Purchase Plan
Disclaimer:
The salary, other compensation, and benefits information is accurate as of the date of this posting.
Cognizant reserves the right to modify this information at any time, subject to applicable law.
Cognizant will only consider applicants for this position who are legally authorized to work in the United States without requiring company sponsorship now or at any time in the future.
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Clinical Registered Nurse – Utilization Management – Remote
role at
Cognizant .
Schedule:
Monday to Friday – Eastern Time
Location:
Remote
About The Role As a Registered Nurse you will make an impact by performing advanced level work related to clinical denial management and managing clinical denials from Providers to the Health Plan/Payer. The process includes analyzing, reviewing, and processing medical necessity denials for resolution. You will be a valued member of the Cognizant team and work collaboratively with stakeholders and other teams.
In This Role, You Will
Maintain ownership and responsibility for assigned accounts.
Maintain working knowledge of applicable health insurers’ internal claims, appeals, and retro‑authorization as well as timely filing deadlines and processes.
Review clinical denials including but not limited to referral, preauthorization, medical necessity, non‑covered services, investigational/experimental and billing resulting in denials and/or delays in payment.
Draft and submit the medical necessity determinations to the Health Plan/Medical Director based on the review of clinical documentation in accordance with Medicare, Medicaid, and third‑party guidelines.
Effectively document and log claims/appeals information on relevant tracking systems.
Utilize critical thinking skills to interpret guidelines of internal policies for clinical determination.
Medical necessity reviews can be based on InterQual, Milliman Clinical Guidelines (MCG), Medicare guidelines, and health insurer specific guidelines.
Review retro‑authorizations in accordance with health insurer requirements and follow insurer process guidelines.
Identify denial patterns with clients to mitigate risk and minimize regulatory penalties.
Escalate potential risks to client, client partners and/or leadership.
Demonstrate critical thinking skills to interpret guidelines of internal policies for clinical determination.
We strive to provide flexibility wherever possible. This is a remote position open to qualified applicants in the United States, and we support a healthy work‑life balance through wellbeing programs.
What You Need To Have To Be Considered
Educational background – Registered Nurse (RN)
2‑3 years combined clinical and/or utilization management experience with a managed health care plan
3 years’ experience in health care revenue cycle or clinic operations
Experience in utilization management including Clinical Appeals and Grievances, precertification, initial and concurrent reviews
Intermediate Microsoft Office knowledge (Excel, Word, Outlook)
In‑patient and outpatient experience
These will help you stand out
Epic experience
Experience in drafting appeals disputing inpatient clinical validations audits is a plus.
We’re excited to meet people who share our mission and can make an impact in a variety of ways. Don’t hesitate to apply, even if you only meet the minimum requirements listed. Think about your transferable experiences and unique skills that make you stand out.
Salary and Other Compensation Applications will be accepted until Jan 9, 2026.
The annual salary for this position is between
$70,000 – $74,000
depending on experience and other qualifications of the successful candidate.
This position is also eligible for Cognizant’s discretionary annual incentive program and stock awards, based on performance and subject to the terms of Cognizant’s applicable plans.
Benefits
Medical/Dental/Vision/Life Insurance
Paid holidays plus Paid Time Off
401(k) plan and contributions
Long‑term/Short‑term Disability
Paid Parental Leave
Employee Stock Purchase Plan
Disclaimer:
The salary, other compensation, and benefits information is accurate as of the date of this posting.
Cognizant reserves the right to modify this information at any time, subject to applicable law.
Cognizant will only consider applicants for this position who are legally authorized to work in the United States without requiring company sponsorship now or at any time in the future.
#J-18808-Ljbffr