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

OWpVMUMxU3RBNTZ6ZUlrZ2dnK1ZpUzA3Nmc9PQ==
  • 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, Remote job,

Similar Jobs

Pinole Valley High School

AP Spanish Teacher Part Time Job at Pinole Valley High School

 ...have in high school. Emery High is looking for a one period AP Spanish teacher for the 2025-26 school year, August--June and taking on...  ...educators. You can even tell us what time of day you want to teach the class (we haven't built the master schedule yet). We are... 

ExcelliSearch, Inc.

IBM InfoSphere Consultant (part-time / remote) Job at ExcelliSearch, Inc.

 ...services company, is looking for an InfoSphere resource who will perform the following work at one of their ongoing clients. Install IBM InfoSphere (Information Server) in AWS Move configuration from current environment to AWS Assist with testing Move to... 

Choate USA

Contract Administrator Job at Choate USA

 ...looking for a detail-oriented Contract Administrator with superior communication skills and the...  ...the company and with customers Data entry, keep up digital records, research, and...  ...(well train, but this is not an entry level position.)~2-5 years relevant experience... 

McGriff

Traveling Health & Wellness Nurse Coach Job at McGriff

 ...risk assessments, help employees navigate wellness offerings, and drive individual accountability of health through personalized coaching to help employers get control over their healthcare costs. Peak Health is a recognized behavioral change and nurse coaching leader... 

Blundstone USA

Social Media Manager Job at Blundstone USA

 ...Position Overview: The Social Media Manager will oversee all aspects of Blundstone USAs social media presence. This role is integral in driving brand engagement, growing our online communities, and crafting authentic content that aligns with Blundstones identity. Reporting...