Top 18 Cobalt Group Jobs

Utilization Review Nurse
Cobalt Benefits Group LLC —Orlando, FL
- $90,000 - $98,000 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Health savings account
- AD&D insurance
Quick Apply
Sales Operation Specialist
Cobalt Benefits Group LLC —South Burlington, VT
- $65,000 - $75,000 a year
- Full-time
- Hybrid work
- Mid-level
- Bachelor's degree
- 1 year
- Health savings account
- AD&D insurance
Quick Apply
Eligibility Benefits Representative
Cobalt Benefits Group LLC —Exeter, NH
- $21.50 - $23.00 an hour
- Full-time
- Office
- Organizational skills
- Medical terminology
- Flexible spending account
Quick Apply
4d
Healthcare Benefits Claims Examiner Representative
Cobalt Benefits Group LLC —Exeter, NH
- $21 - $22 an hour
- Full-time
- Customer service
- Windows
- Typing
- Health savings account
- AD&D insurance
Quick Apply
Claims Integrity Analyst
Cobalt Benefits Group LLC —South Burlington, VT
- $65,000 - $75,000 a year
- Full-time
- Research
- Mid-level
- 3 years
- Health savings account
- AD&D insurance
Quick Apply
IT Systems Support Specialist
Cobalt Benefits Group LLC —Exeter, NH
- $55,000 - $65,000 a year
- Full-time
- Mid-level
- Windows
- 3 years
- Health savings account
- AD&D insurance
Quick Apply
Customer Service Representative
Cobalt Benefits Group LLC —United States
- $23 an hour
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- HIPAA
- Health savings account
- AD&D insurance
Quick Apply
3d
Healthcare Claims Refund Specialist
Cobalt Benefits Group LLC —United States
- $21 - $22 an hour
- Multiple hires
- Remote
- Computer literacy
- Research
- Windows
- Health savings account
- AD&D insurance
Quick Apply
Health Benefits Implementation Specialist
Cobalt Benefits Group LLC —United States
- $65,000 - $80,000 a year
- Full-time
- Remote
- Mid-level
- Presentation skills
- Travel
- Health savings account
- AD&D insurance
Quick Apply
Director, Utilization Review
Cobalt Benefits Group LLC —United States
- $135,000 - $155,000 a year
- Full-time
- RN License
- 5 years
- Senior level
- Health savings account
- AD&D insurance
Quick Apply

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Utilization Review Nurse

Cobalt Benefits Group LLC -
Orlando, FL

Quick Apply

Job Details

Full-time
$90,000 - $98,000 a year

Benefits

Health savings account
AD&D insurance
Paid holidays
Disability insurance
Health insurance
Dental insurance
Flexible spending account
Tuition reimbursement
Vision insurance

Qualifications

Computer operation
Microsoft Excel
Microsoft Outlook
RN License
Patient care
Desktop applications
Resource utilization in healthcare

Full Job Description

Description:

Join our team at Cobalt Benefits Group and start an exciting new career in employee benefits solutions. As a Utilization Review Nurse (UR Nurse), you’ll play an important role in helping us offer customized, self-funded insurance options to our clients and members.

The UR Nurse is responsible for reviewing clinical information to determine the medical necessity, appropriateness, and efficiency of healthcare services, procedures, and levels of care in accordance with established criteria, payer guidelines, and organizational policies. This role involves evaluating healthcare services and facilities under the provisions of applicable health benefit plans to ensure quality and cost-effective patient care.

The UR Nurse collaborates closely with intake staff, physicians, specialists, case managers, and other members of the care team to facilitate timely and effective care authorizations, transitions, and utilization determinations. Strong communication, clinical judgment, and attention to detail are essential to ensure services meet both clinical standards and benefit requirements.

Responsibilities

Perform utilization and concurrent reviews of inpatient cases using Milliman, Aetna, and BCBS criteria.
Conduct medical necessity reviews for services requiring prior authorization, applying utilization-specific criteria.
Request and evaluate clinical information needed to review requested services.
Discuss cases and determinations with healthcare professionals and physician reviewers.
Identify cases requiring intervention and collaborate with Case Managers as needed.
Maintain appropriate and accurate documentation, ensuring compliance with audit standards.
Participate in team meetings, educational sessions, and related activities.
Review medical claims and pre-determinations for medical necessity and appropriateness.
Identify opportunities for process improvement and enhance communication among departments.
Consult with Physician Reviewers for complex or challenging cases.

Requirements:

Current, unrestricted RN license (State license required).
Minimum 3 years of clinical nursing experience.
Minimum 1 year of Utilization Management (UM) or Utilization Review (UR) experience.
Strong analytical, critical thinking, and problem-solving skills.
Proficiency in Microsoft Office Suite (Excel, Word, Outlook) and familiarity with utilization management systems.
Excellent verbal and written communication skills, with the ability to interact effectively with internal and external stakeholders.
Strong organizational and time management skills, with the ability to handle multiple priorities independently.

Preferred Qualifications

Experience with Milliman or Aetna criteria.
Background in healthcare administration, medical necessity determination, or benefits management.
Experience in data interpretation and medical trend analysis.

Work Environment & Physical Demands

Prolonged periods of sitting may be required.
Regular use of a computer, keyboard, and mouse is necessary; reasonable accommodations will be provided upon request.
Employees should ensure an ergonomically appropriate desk and chair setup.
Comfort with being on camera for virtual meetings (e.g., Microsoft Teams)

Benefits

After successfully completing a waiting period, eligible full-time employees have access to our comprehensive benefits package, including:

Fantastic medical, dental, and vision insurance*
Twice annual employer HSA contributions, covering 50% of the HDHP plan’s annual deductible!
Company-provided Basic Life and AD&D
Company-paid Short-Term and Long-Term Disability**
Flexible Spending Accounts*
401(k) Retirement Plan with up to a 6% employer match** (100% fully vested after 3 years)
10+ paid holidays
Half-day Summer Fridays
Generous paid vacation and sick time
Annual paid Volunteer Day
Annual Tuition reimbursement
Annual Health and Wellness reimbursement
Lots of fun company events

Benefit Waiting Period Notes: *60-day waiting period, **90-day waiting period

Who We Are

As a trusted Third-Party Administrator (TPA) specializing in self-funded benefit plans, Cobalt Benefits Group (CBG) is committed to helping employers find high-quality coverage at a cost they can afford. We administer self-funded insurance benefits through our four companies: EBPA, Blue Benefit Administrators of Massachusetts, CBA Blue, and Great Bay Administrators. With over 30 years of experience and a dedicated team of nearly 300 employees, we work collaboratively to build customized self-funded health plans, manage claim payments and disputes, and administer other specialized programs such as FSAs, HSAs, COBRA, and retiree billing. Cobalt Benefits Group is one of the fastest growing TPA's in the country and the fastest growing in New England. Join us as we match employers across our region with the right solutions for their employee benefit needs. To learn more about working at CBG, visit www.cobaltbenefitsgroup.com/careers.

Quick Apply

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Cobalt Group jobs

Utilization Review Nurse

Sales Operation Specialist

Eligibility Benefits Representative

Healthcare Benefits Claims Examiner Representative

Claims Integrity Analyst

IT Systems Support Specialist

Customer Service Representative

Healthcare Claims Refund Specialist

Health Benefits Implementation Specialist

Director, Utilization Review

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