Registered Nurse

Pyramid Consulting; United States; Remote; USD 51,000 - 54,000; Full time

Benefits offered by this job

health insurance

401(k) plan

paid sick leave

Job summary

Pyramid Consulting, Inc. is hiring a Registered Nurse for a remote US contract role. You will review Medicaid prior authorization requests, apply InterQual criteria, and determine medical necessity while maintaining high productivity.

The position requires 3+ years of RN experience, compact license, and strong documentation skills. Collaboration with a remote team and attention to compliance are essential.

Qualifications

• Active RN license (compact) required.
• Experience with InterQual criteria and Medicaid utilization management.
• 3+ years of clinical experience in a review/UR role.
• Experience with prior authorization and MCOs.

Responsibilities

• Review prior authorization requests across Medicaid categories.
• Apply state-specific clinical coverage policies and InterQual criteria to evaluate medical necessity.
• Refer cases not meeting criteria to a physician or second-level reviewer for final determination.
• Process 12–15 clinical reviews per day while maintaining accuracy and productivity.
• Maintain clear, timely documentation of clinical reviews and decisions.
• Manage assigned cases using spreadsheets and relevant clinical review systems.
• Communicate effectively with team and contribute to a collaborative remote work environment.

Skills

RN license

InterQual criteria

Medicaid UM

Prior authorization

MCO experience

Remote collaboration

3+ years exp

Job description

Registered Nurse

Job ID: 26-31615

Contract: 06+ months contract

Location: U.S (Remote)

Pay Range: $37 - $39/hour.

Employee benefits include, but are not limited to:

• health insurance (medical, dental, vision)


• 401(k) plan


• paid sick leave (depending on work location)

Key Responsibilities

• Review prior authorization requests across various healthcare service categories for Medicaid members.


• Apply state-specific clinical coverage policies and InterQual criteria to evaluate medical necessity and determine whether requests meet established guidelines.


• Refer cases that do not meet clinical criteria to a physician or appropriate second-level reviewer for final determination.


• Process approximately 12–15 clinical reviews per day while maintaining accuracy and productivity standards.


• Maintain clear, accurate, and timely documentation of clinical reviews and decisions.


• Manage assigned cases using spreadsheets and relevant clinical review systems.


• Communicate effectively with team members and contribute to a collaborative remote work environment.

Key Requirements and Technology Experience

• Key Skills; Active RN compact license.


• Experience using InterQual criteria.


• Familiarity with Medicaid utilization management and medical necessity reviews.


• Ability to adapt quickly in a fast-paced clinical review environment.


• Compact state license (required).


• 3+ years of relevant clinical experience.


• Experience with prior authorization requests.


• MCO experience is a must.


• Strong computer skills and the ability to navigate multiple systems and manage electronic documentation.


• Excellent organizational, communication, and time-management skills.


• Ability to work independently while collaborating effectively with a remote team.

Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions.

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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