Clinical Review Nurse - Concurrent Review

Pyramid Consulting, Inc; Dallas (TX); On-site; USD 100,000 - 125,000; Full time

Job summary

A leading healthcare company is seeking a Clinical Review Nurse for a 6+ month contract in Dallas, TX. The role involves reviewing medical documents and managing authorizations, requiring a Texas RN License and prior authorization experience. Competitive pay and employee benefits are included.

Benefits

Health insurance (medical, dental, vision)

401(k)

Paid sick leave

Qualifications

• Prior Authorization experience required.
• Texas RN License or Compact State RN License is mandatory.
• Experience in ICU or ER, Utilization Management, or Case Management preferred.

Responsibilities

• Review handwritten and computer-generated documents.
• Complete authorization reviews within a 24-hour turnaround time.
• Manage approximately 12-20 authorizations per day.

Skills

Strong communication

Computer skills

Prior Authorization experience

Education

Texas RN License or Compact State RN License

Tools

Microsoft Office

Job description

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Clinical Review Nurse - Concurrent Review New

Immediate need for a talented Clinical Review Nurse - Concurrent Review. This is a 6+ months contract opportunity with long-term potential, located in Dallas, TX (Remote). Please review the job description below and contact me ASAP if interested.

Job ID: 25-71194

Pay Range: $35 - $39/hour. Employee benefits include health insurance (medical, dental, vision), 401(k), and paid sick leave (depending on work location).

Key Responsibilities:

• Review handwritten and computer-generated documents, prioritizing tasks effectively.
• Complete authorization reviews within a 24-hour turnaround time (TAT) in Texas.
• Send cases not meeting medical necessity to a medical director for review.
• Follow up with the UM department via phone/fax for denied authorizations, offering peer-to-peer reviews before official denial.
• Manage approximately 12-20 authorizations per day, including new and concurrent reviews.
• Aim for individual hourly productivity of 2.49-3.21 to meet expectations.
• Send cases not meeting medical necessity criteria to MD review.
• Maintain a concurrent review referral rate of 30%-40%.
• Complete Enterprise Compliance courses timely within the university system.
• Participate in onboarding, including logging into VPN and Trucare, and shadowing preceptors.
• Engage in a learning journey about Trucare Classic, Interqual reviews, and the Ambetter line of business, with shadowing, precepting, and independent work.

Key Requirements and Technology Experience:

• Prior Authorization experience.
• Texas RN License or Compact State RN License.
• Strong communication and computer skills.
• Experience in ICU or ER, Utilization Management, or Case Management.
• Proficiency with Microsoft Office, including Excel.
• Ability to toggle between different screens and learn quickly due to high volume.
• Experience with InterQual and Ambetter is a plus.

Our client is a leading Healthcare Industry. We are currently interviewing for this and similar contract positions. If interested, please apply online for immediate consideration.

Pyramid Consulting, Inc. provides equal employment opportunities and prohibits discrimination and harassment of any kind.

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