Prior Auth RN/ Clinical Review Nurse Job at Pyramid Consulting, Inc, Charlotte, NC

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  • Pyramid Consulting, Inc
  • Charlotte, NC

Job Description

Job Description

Immediate need for a talented Prior Auth RN/ Clinical Review Nurse . This is a 03+months contract opportunity with long-term potential and is located in Charlotte, NC (Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID: 25-82861

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:

  • 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 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
  • Provides feedback on opportunities to improve the authorization review process for members
  • Performs other duties as assigned
  • Complies with all policies and standards

Key Requirements and Technology Experience:

  • Key Skills; RN
  • Prior Auth
  • Utilization management
  • Must haves: 2 years experience with PA or IP auth reviews
  • Nice to haves: Previous experience with NC State Criteria/ InterQual Criteria
  • Education/Certification ; Required: LPN/AS RN
  • Licensure; Required: i.e. RN, LPN

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, 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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Job Tags

Contract work, Local area, Immediate start,

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