Utilization RN Job at Pyramid Consulting, Inc, Dallas, TX

dE9pMHZjNWhzMGhXMUhyMGp6aWdETzNvNHc9PQ==
  • Pyramid Consulting, Inc
  • Dallas, TX

Job Description

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 .

Job Tags

Contract work, Local area, Immediate start,

Similar Jobs

Penn Creative

Senior Graphic Designer Job at Penn Creative

 ...reside in the Greater Philadelphia area Annual Salary: $70,000 About This Position Imagine what you could do here! At Penn Creative, we create compelling print and digital solutions for sophisticated clients. But were not just looking for a graphic designer. We... 

Insight Global

Accounts Payable Manager Job at Insight Global

 ...A global leader in apparel manufacturing and marketing is seeking a seasoned Accounts Payable Manager to lead a team of five in a high-volume, multi-entity environment. This role is responsible for overseeing the full-cycle AP process, ensuring accuracy, compliance, and... 

Home Health Care, Inc.

Activities Assistant Job at Home Health Care, Inc.

 ...Job Title: Activities / Life Enrichment Assistant Company: Sunflower Communities Schedule: Full-Time + Weekend Rotation Required...  ...for aging adults in Minnesota. Our mission is to offer quality health and housing services that promote independence and well-being... 

E&R Logix LLC

Amazon Delivery Driver Job at E&R Logix LLC

 ...work independently and make a difference?E&R Logix LLC, an Amazon Delivery Service Partner (DSP) inCoraopolis, PA, is hiringDelivery Associates...  ...5108as part of our dedicated local team. Amazon Delivery Driver Compensation & Benefits: ~ Starting Pay Rate is $21.75 up... 

Compass Group

DISHWASHER (TEMPORARY) Job at Compass Group

 ...for temporary DISHWASHER positions. Location : Memorial Hospital Belleville - 4500 Memorial Drive, Belleville, IL 62226. Note:...  ...vary. More details upon interview. Requirement : No previous experience required. Perks: Willing to train! Fixed Pay Rate: $16.5...