Registered Nurse
Pyramid Consulting
1 day ago
Contract
Remote
United States
$37 - $39 USD hourly
General
Immediate need for a talented Registered Nurse. This is a 06+months contract opportunity with long-term potential and is located in U.S(Remote). Please review the job description below and contact me ASAP if you are interested.
Job ID:26-31615
Pay Range: $37 - $39/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here.
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Job ID:26-31615
Pay Range: $37 - $39/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:
- Review prior authorization requests across various healthcare service categories for Medicaid members.
- Apply state-specific clinical coverage policies and InterQual criteria to evaluate medical necessity and determine whether requests meet established guidelines.
- Refer cases that do not meet clinical criteria to a physician or appropriate second-level reviewer for final determination.
- Process approximately 12–15 clinical reviews per day while maintaining accuracy and productivity standards.
- Maintain clear, accurate, and timely documentation of clinical reviews and decisions.
- Manage assigned cases using spreadsheets and relevant clinical review systems.
- Communicate effectively with team members and contribute to a collaborative remote work environment.
- Key Skills; Active RN compact license.
- Experience using InterQual criteria.
- Familiarity with Medicaid utilization management and medical necessity reviews.
- Ability to adapt quickly in a fast-paced clinical review environment.
- Compact state license (required).
- 3+ years of relevant clinical experience.
- Experience with prior authorization requests.
- MCO experience is a must.
- Strong computer skills and the ability to navigate multiple systems and manage electronic documentation.
- Excellent organizational, communication, and time-management skills.
- Ability to work independently while collaborating effectively with a remote team.
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here.
#prof