Clinical Review Nurse - Prior Authorization

Pyramid Consulting, Inc; Charlotte (NC); Remote; USD 80,000 - 100,000; Full time

Job summary

An innovative healthcare organization is seeking a dedicated Clinical Review Nurse for Prior Authorization. This role involves reviewing medical records and collaborating with a supportive team to ensure efficient processing of outpatient authorization requests. With a focus on communication and teamwork, you'll thrive in a dynamic environment where your expertise in Utilization Management will shine. This is an exciting opportunity for a nursing professional looking to make a significant impact in patient care while enjoying the flexibility of a remote position. Join a forward-thinking organization that values your contributions and offers a competitive pay structure.

Benefits

Health Insurance (Medical, Dental, Vision)

401(k) Plan

Paid Sick Leave

Qualifications

• 1+ years of Utilization Management experience.
• 3+ years of nursing experience.

Responsibilities

• Review medical records for outpatient medical prior authorization requests.
• Collaborate with team members for support and guidance.

Skills

Prior Authorization

Clinical Review

Utilization Review

Tools

TruCare

MCG

Interqual

Job description

Immediate need for a talented Clinical Review Nurse - Prior Authorization. This is a 03+ Months Contract opportunity with long-term potential, located remotely in North Carolina. Please review the job description below and contact me ASAP if interested.

Job ID : 25-63772

Pay Range : $37 - $39 / hour. Employee benefits include health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities :

1. Review medical records and collaborate with other disciplines within the plan to clinically review outpatient medical prior authorization requests from providers, primarily based on state Medicaid policy.
2. Work with a supportive, experienced team that values communication, guidance, and collaboration. Daily interactions include answering questions and providing support via team group chat.
3. Receive daily assignments with a productivity expectation of completing more than 16 authorizations per day, approximately 2 per hour.

Key Requirements and Technology Experience :

1. Skills: "PRIOR AUTHORIZATION", "CLINICAL REVIEW", and "UTILIZATION REVIEW".
2. At least 1 year of Utilization Management experience.
3. At least 1 year of Prior Authorization experience using TruCare, MCG, or Interqual.
4. 3+ years of nursing experience.

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

Pyramid Consulting, Inc. is an equal opportunity employer and prohibits discrimination and harassment of any kind.

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