RN (Registered Nurse)

Pyramid Consulting, Inc; Missouri; Remote; USD 67,000 - 68,000; Full time

Job summary

An established industry player is seeking a dedicated Registered Nurse for a full-time remote opportunity in Missouri. This role offers the chance to leverage your nursing expertise while reviewing medical documentation and making critical payment determinations. With a focus on collaboration with healthcare professionals, you'll play a vital role in ensuring quality patient care. Enjoy a competitive salary and comprehensive benefits, including health insurance and a 401(k) plan. If you're passionate about making a difference in healthcare, this is the perfect opportunity for you.

Benefits

Health insurance (medical, dental, vision)

401(k) plan

Paid sick leave

Qualifications

• Active Missouri Nursing License required.
• 1+ year of professional nursing experience or 2+ years from nursing school.

Responsibilities

• Review patient medical documentation for claims and authorizations.
• Make decisions based on MHD policy and nursing judgment.

Skills

Registered Nurse (RN)

Excellent written communication

Excellent verbal communication

Utilization review experience

Education

Bachelor's degree in nursing

Graduate of a nursing school

Tools

MMIS

Exceptions database

Job description

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Immediate need for a talented RN (Registered Nurse). This is a Full-time opportunity with long-term potential, located in Missouri (Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID: 25-68406

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

• Review patient medical documentation and make online payment determinations for claims and prior authorizations that require medical determination.
• Review exception requests under the direction of MO HealthNet Division (MHD) staff.
• Decisions are based on MHD policy and professional nursing judgment and experience.
• Use MMIS and exceptions database to process review outcomes.
• Work with healthcare professionals to review requests for non-covered services.
• Review requests for medical services and supplies.

Key Requirements and Technology 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 graduate of a nursing school with at least two years of experience.
• Experience in varied nursing backgrounds (hospital, physician’s office, outpatient facility, UR, etc.).
• Computer skills and utilization review experience are desired.
• Excellent written and verbal communication skills.

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

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants and prohibits discrimination and harassment of any kind.

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