Job Description
Job Overview Third-Party Administrator (TPA) We are seeking an experienced and compassionate Registered Nurse to join our team in a dynamic dual-role position combining Case Management and Utilization Review responsibilities within a Third-Party Administrator (TPA) environment. This role is ideal for an RN who enjoys applying clinical expertise in a collaborative, non-bedside setting while supporting quality member outcomes, appropriate utilization of healthcare services, and effective care coordination. The nurse will work closely with providers, members, facilities, pharmacy benefit managers (PBMs), stop-loss carriers, insurance brokers, and health plan partners to ensure medically appropriate, cost-effective, and member-centered care. The ideal candidate is a collaborative and self-directed RN who thrives in a fast-paced managed care environment and enjoys integrating member advocacy with clinical review responsibilities. Successful candidates are adaptable, solutions-focused, data-...