RN (Registered Nurse)

Pyramid Consulting, Inc; Jefferson City (MO); Remote; USD 67,000 - 68,000; Full time

Job summary

Pyramid Consulting, Inc. is seeking a Registered Nurse (RN) for a remote full-time position in Missouri. The role involves reviewing medical documentation, collaborating with healthcare professionals, and making informed decisions on claims. Ideal candidates will have a Bachelor’s degree in nursing and an active Missouri Nursing License, along with relevant experience in various nursing settings.

Benefits

Health insurance (medical, dental, vision)

401(k) plan

Paid sick leave

Qualifications

• Registered Nurse (RN) with an active Missouri Nursing License.
• Bachelor’s degree in nursing or equivalent experience.
• Experience in varied nursing settings preferred.

Responsibilities

• Review patient medical documentation for claims and prior authorizations.
• Collaborate with healthcare professionals on service requests.
• Make review decisions based on MHD policy and nursing judgment.

Skills

Communication

Utilization Review

Clinical Review

Education

Bachelor’s degree in nursing

Active Missouri Nursing License

Job description

Job Title: Registered Nurse (RN) - Remote

Immediate opening for a talented Registered Nurse (RN). This is a full-time position with long-term potential, located in Missouri (Remote). Please review the job description below and contact us ASAP if interested.

Job ID: 25-68406

Pay Range: $67,000 - $68,000 per annum

Employee benefits include health insurance (medical, dental, vision), 401(k) plan, and paid sick leave, depending on work location.

Key Responsibilities:

• Review patient medical documentation and make online payment determinations for claims and prior authorizations requiring medical review.
• Assess exception requests under the guidance of MO HealthNet Division (MHD) staff.
• Make review decisions based on MHD policy, professional nursing judgment, and experience.
• Utilize MMIS and exceptions database to process review outcomes.
• Collaborate with healthcare professionals to review requests for non-covered services.
• Review requests for medical services and supplies.

Key Requirements and Experience:

• Registered Nurse (RN) with an active Missouri Nursing License.
• Bachelor’s degree in nursing with at least one year of professional nursing experience, or a graduate of a nursing school with at least two years of experience.
• Experience in varied nursing settings (hospital, physician’s office, outpatient facility, utilization review, etc.).
• Experience with utilization review, claims review, and clinical review is preferred.
• Excellent written and verbal communication skills.
• Computer skills and utilization review experience are desirable.

Our client is a leading IT industry. We are currently interviewing for this and similar full-time positions. If interested, please apply online for immediate consideration.

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

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