Utilization Management RN - Prior Authorization

Pyramid Consulting; United States; Remote; USD 52,000 - 55,000; Full time

Job summary

Pyramid Consulting is seeking an Utilization Management RN for a 12+ month contract opportunity with a remote location in the United States. The role focuses on prior authorization, clinical document review, and timely case management.

Strong nursing credentials and IRN licensure are required for immediate interviews. Responsibilities include prioritizing cases, reviewing records, requesting missing information, and participating in team activities while ensuring accuracy and adherence to

Qualifications

• Must be a graduate from an accredited school of nursing or have a bachelors degree in nursing.
• 2+ years of clinical nursing experience; utilization management, managed care, or prior authorization experience preferred.
• Active RN licensure required.
• Strong critical thinking, organization, attention to detail, and professional communication skills.
• Proficiency with electronic clinical systems, Microsoft Office, and remote collaboration tools.
• Experience in case management within required turnaround times.
• Familiarity with medical-necessity criteria and clinical documentation standards.

Responsibilities

• Prioritize assigned cases based on urgency and turnaround time.
• Review clinical records against applicable criteria and benefits, documenting findings accurately.
• Communicate requests for missing information and escalate cases outside nursing authority.
• Participate in team huddles, respond to inquiries, and complete administrative tasks.
• Measure performance through quality and documentation accuracy, productivity, and adherence to policies.

Skills

Critical thinking

Organization

Attention to detail

Professional communication

Remote collaboration

Education

Bachelors degree in Nursing

Graduate from Accredited School of Nursing

Tools

Electronic clinical systems

Microsoft Office

Remote collaboration tools

Job description

Utilization Management RN - Prior Authorization

Immediate need for a talented Utilization Management RN - Prior Authorization. This is a 12+ Months Contract opportunity with long-term potential and is located in US (Remote).

Job ID:26-31179

Pay Range: $38 - $40/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:

• Prioritize assigned cases based on urgency and turnaround time.
• Review clinical records against applicable criteria and benefits, documenting findings accurately.
• Communicate requests for missing information and escape cases outside nursing authority.
• Participate in team huddles, respond to inquiries, and complete administrative tasks.
• Measure performance through quality and documentation accuracy, productivity, and adherence to policies.

Key Requirements and Technology Experience:

• Required: Graduate from an Accredited School of Nursing or bachelor’s degree in nursing.
• 2+ years of clinical nursing experience; experience in utilization management, managed care, or prior authorization is preferred.
• Required: Active RN licensure.
• Strong critical thinking, organization, attention to detail, and professional communication skills.
• Proficiency with electronic clinical systems, Microsoft Office, and remote collaboration tools.
• Experience in case management within required turnaround times.
• Familiarity with medical-necessity criteria and clinical documentation standards.

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, 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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