Utilization RN

Pyramid Consulting, Inc; Dallas (TX); Remote; USD 80,000 - 100,000; Full time

Job summary

Pyramid Consulting, Inc is seeking a Utilization RN for a 10+ month contract in Dallas, TX (remote options available). The role involves analyzing prior authorizations, coordinating care with medical teams, and ensuring compliance with healthcare guidelines. Ideal candidates will possess an RN degree and relevant experience in utilization management.

Benefits

Health insurance (medical, dental, vision)

401(k) plan

Paid sick leave

Qualifications

• Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing required.
• 2 - 4 years of related experience in healthcare utilization management.
• Strong analytical skills and ability to coordinate with healthcare providers.

Responsibilities

• Analyze prior authorization requests for medical necessity.
• Coordinate care with healthcare providers and teams.
• Document and maintain member’s clinical information in compliance with guidelines.

Skills

RN

Utilization Management

Appeals

Education

Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing

Job description

3 weeks ago Be among the first 25 applicants

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Immediate need for a talented Utilization RN. This is a 10+months contract opportunity with long-term potential and is located in Dallas,TX(Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID:25-69315

Pay Range: $35 - $38/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:

• Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage.
• Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care.
• Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care.
• Coordinates as appropriate with healthcare providers and interdepartmental teams, to assess medical necessity of care of member.
• Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of care.
• Assists with service authorization requests for a member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities.
• Collects, documents, and maintains all member’s clinical information in health management systems to ensure compliance with regulatory guidelines.
• Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to members.
  
  

Key Requirements and Technology Experience:

• Key Skills:RN ,Utilization Management ,Appeals .
• Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 - 4 years of related experience.
  
  

Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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.

By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here.

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Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Other

• Industries

  IT Services and IT Consulting

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