Prior Auth Registered Nurse

Pyramid Consulting, Inc; Huntsville (AL); Remote; USD 60,000 - 80,000; Full time

Job summary

Pyramid Consulting, Inc is seeking a Prior Auth Registered Nurse for a remote contract role with a key focus on clinical criteria prior authorization setup. This position offers competitive hourly pay, benefits, and the opportunity to work in a dynamic, consultative environment. Ideal candidates must have a current RN license and demonstrate strong communication and organizational skills.

Benefits

Health insurance (medical, dental, vision)

401(k) plan

Paid sick leave

Qualifications

• Requires RN license in good standing as per state regulations.
• Demonstrated team player and collaborative skills.
• Ability to articulate and manage clinical systems effectively.

Responsibilities

• Setup clinical criteria for prior authorizations using web-based platforms.
• Create and code denial rationales and questions for prescriber interactions.
• Provide consultative support for clinical criteria discussions with internal partners.

Skills

Communication

Microsoft Office

Organization

Collaboration

Creative problem-solving

Education

Licensed RN

Job description

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Immediate need for a talented Prior Auth Registered Nurse. This is a 01+ 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: 25-74793

Pay Range: $30 - $31/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:

• No direct patient care. This is a virtual position.
• Responsible for clinical criteria prior authorization setup, which takes client clinical policy requirements and creates the prior authorization request sent to prescribers.
• This could include questions such as (but not limited to) is the patient 18, does this patient have , has the patient tried and failed these alternative medications etc.
• The creation of questions and answers along with other additional configuration will allow prescribers to answer questions leading to either an approval or denial.
• Clinicians are also responsible for creating and coding denial rationales sent to prescribers and patients.
• The system leveraged for this coding is a web-based platform proprietary to ESI, and selected contractor will be trained on how to leverage this platform.
• Additionally, the individuals should have strong skills with Microsoft office, particularly excel.
• Configuration support will be for both pharmacy and medical criteria and will require good creative problem-solving skills to ensure appropriate setup to meet client needs and maximum operation efficiency.
• Consultative support in explaining setup and system requirements might be needed if discussing criteria setup with other internal ESI business partners.
• An individual with strong and effective communication skills is highly desired.
  
  

Key Requirements and Technology Experience:

• Key skills; Licensed RN
• Responsible for clinical criteria prior authorization setup, which takes client clinical policy requirements and creates the prior authorization request sent to prescribers
• Communication, MicroSoft Office, Organization, Self-Driven, Collaboration
• Communication, MicroSoft Office, Organization, Self-Driven, Collaboration
• Demonstrates 'Team Player' and collaborative skills within internal and external teams
• Takes risks by thinking strategically about problems and challenges within their domain
• Communicates effectively within peer group and subordinate groups
• Holds oneself accountable for designated client relationships and the delivery of requests associated to service.
• Capable of & develops robust operational controls to maximize service levels.
• Able to identify the needs of clinical system or process changes to help enhance service levels.
• Ability to comprehend and articulate the importance of assigned responsibilities and controls.
• Able to mitigate concerns of business partners within direct scope of responsibility.
• Able to clearly communicate directly with clients when providing consultative services.
• Licensed RN
• Good communication
• Attention to detail
• Requires RN license that is in good standing as required by the state in which work is performed
  
  

Our client is a leading Insurance 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, color, 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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Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Other

• Industries

  IT Services and IT Consulting

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