Immediate need for a talented Clinical Review Nurse - Prior Authorization. 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:25-62904

Pay Range: $30 - $34/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:

Client’s commitment to diversity and inclusion is a part of who we are, and we support diversity of ideas and people by fostering open communication, encouraging inclusive decision-making, and actively promoting a team composition that values diverse backgrounds and perspectives.
Candidates will be particularly interested in the collaborative and supportive team environment, enhanced by a democratic leadership style that values each team member's input and fosters a culture of creativity and continuous improvement.
This approach not only enhances job satisfaction but also drives high productivity making it an ideal setting for professionals eager to contribute meaningfully while growing their skills in a positive and inclusive workplace.
UM is highly focused on how we can be better partners to our external stakeholders, answering the question of “how can make it easy to work with us?”
Specifically, this role will impact the member and provider experience, and this nurse will be responsible for ensuring communication excellence and unbiased application of policy and state regulations to ensure best possible member health outcomes.
Routinely reviews prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage.
Assesses more complex authorization requests and provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care.
Candidates will be particularly interested in the collaborative and supportive team environment, enhanced by a democratic leadership style that values each team member's input and fosters a culture of creativity and continuous improvement.
This approach not only enhances job satisfaction but also drives high productivity making it an ideal setting for professionals eager to contribute meaningfully while growing their skills in a positive and inclusive workplace.

Key Requirements and Technology Experience:

Key Skills: Prior Authorization ,Utilization Review ,InterQual, Milliman .
Prior PA experience required, experience in InterQual/ Milliman, One Note, knowledge of Utilization Management (policies/regulations),
Prior preservice or prior authorization in Utilization Management department experience required.
There is no exception to this required minimum skills experience.
Experience in InterQual or Milliman
Organizational skills, detailed oriented, able to work independently and make decision in fast paced role, disciplined, technology dexterity, change management minded, Customer centricity minded.
Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2-4 years of experience.
LPN - Licensed Practical Nurse - State Licensure required Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria.

Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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.

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