[Hiring] Registered Nurse @Pyramid Consulting

Role Description

Immediate need for a talented Registered Nurse. This is a 06+ months contract opportunity with long-term potential and is located in U.S (Remote).

Key Responsibilities:

• Review prior authorization requests across various healthcare service categories for Medicaid members.
• Apply state-specific clinical coverage policies and InterQual criteria to evaluate medical necessity and determine whether requests meet established guidelines.
• Refer cases that do not meet clinical criteria to a physician or appropriate second-level reviewer for final determination.
• Process approximately 12–15 clinical reviews per day while maintaining accuracy and productivity standards.
• Maintain clear, accurate, and timely documentation of clinical reviews and decisions.
• Manage assigned cases using spreadsheets and relevant clinical review systems.
• Communicate effectively with team members and contribute to a collaborative remote work environment.

Qualifications

• Active RN compact license.
• Experience using InterQual criteria.
• Familiarity with Medicaid utilization management and medical necessity reviews.
• Ability to adapt quickly in a fast-paced clinical review environment.
• Compact state license (required).
• 3+ years of relevant clinical experience.
• Experience with prior authorization requests.
• MCO experience is a must.
• Strong computer skills and the ability to navigate multiple systems and manage electronic documentation.
• Excellent organizational, communication, and time-management skills.
• Ability to work independently while collaborating effectively with a remote team.

Benefits

• Pay Range: $37 - $39/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).

Company Description

Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions.