What are the responsibilities and job description for the Prior Auth Nurse (RN) position at Pyramid Consulting, Inc?
Immediate need for a talented Prior Auth Nurse (RN). This is a 03 months contract opportunity with long-term potential and is located in Olympia, WA (Remote). Please review the job description below and contact me ASAP if you are interested.
Job ID:25-80708
Pay Range: $37 - $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:
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 [Link available when viewing the job].
#prof J2W:CB3
Job ID:25-80708
Pay Range: $37 - $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:
- Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria.
- Works with healthcare providers and authorization team to ensure timely review of services – Reviewing requests about the member and working with providers.
- 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.
- Provides feedback on opportunities to improve the authorization review process for members.
- Performs other duties as assigned .
- Complies with all policies and standards .
- Key Skills:RN
- Prior Authorization
- Utilization Management
- Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience.
- RN or LPN .
- Must have the licensed requirements sent in, Must reside in SC .
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 [Link available when viewing the job].
#prof J2W:CB3
Salary : $37 - $40
