Prior Auth Registered Nurse.

Pyramid Consulting, Inc; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

A leading consulting firm is seeking a Prior Auth Registered Nurse for a remote contract position. This role focuses on clinical criteria prior authorization setup, involving effective communication and problem-solving. You will work with clinical policies and configure prior authorization requests. Strong Microsoft Office skills are essential, especially in Excel. If you have a valid RN license and a collaborative approach, apply now to join the dynamic team.

Benefits

Health insurance (medical, dental, vision)

401(k) plan

Paid sick leave

Qualifications

• Must hold a valid and active RN license.
• Strong effective communication skills desired.
• Experience with clinical prior authorization processes is essential.

Responsibilities

• Responsible for clinical criteria prior authorization setup.
• Consultative support in explaining setup and system requirements.
• Developing robust operational controls to maximize service levels.

Skills

Communication

Organization

Self-Driven

Collaboration

Creative Problem-Solving

Education

Licensed RN

Tools

Microsoft Office

Job description

Pyramid Consulting, Inc provided pay range

This range is provided by Pyramid Consulting, Inc. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$30.00/hr - $31.00/hr

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
• 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

  Not Applicable

Employment type

• Employment type

  Contract

Job function

• Job function

  Health Care Provider

• Industries

  Insurance

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