Remote RN – Medicaid Prior Authorization & Policy Review

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

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.