UM Nurse/Prior Auth Nurse
Posted 1 week ago by 1752302364
Negotiable
Outside
Remote
USA
Summary: Immediate opportunity for a UM Nurse/Prior Auth Nurse in a remote capacity for a contract lasting over six months, with potential for long-term engagement. The role involves reviewing case files, collaborating with medical teams, and ensuring optimal patient outcomes through clinical reviews. Candidates should possess relevant nursing qualifications and experience in prior authorization and claims processing.
Key Responsibilities:
- Nurses review case files, add, update or edit authorizations.
- Work closely with the MD team to make final decisions on cases.
- The clinical team works closely with their supervisors and senior clinicians on the team for support.
- Team does have group chats on Teams for routine questions.
- Team works closely together along with the coordinator team who owns end to end process on cases.
- Team handles various types of authorization and claim review requests from various markets nationwide.
- Processing clinical reviews to ensure members have the best outcomes and access to care needed.
- Help reduce provider abrasion by processing retrospective claim reviews.
Key Skills:
- RN, Prior Auth, Claims.
- Medicare knowledge, InterQual or Milliman Experience, Clinical reviews for Utilization Management or Appeals.
- Medicare Appeals Experience.
- Associate in nursing, Bachelor’s in nursing or higher.
- RN, LPN.
Salary (Rate): undetermined
City: undetermined
Country: USA
Working Arrangements: remote
IR35 Status: outside IR35
Seniority Level: undetermined
Industry: Healthcare
Immediate need for a talented UM Nurse/Prior Auth Nurse. This is a 06+months contract opportunity with long-term potential and is located in Phoenix, AZ (Remote). Please review the job description below and contact me ASAP if you are interested.
Job ID:25-77859
Pay Range: $30 - $32/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:
- Nurses review case files, add, update or edit authorizations.
- Work closely with the MD team to make final decisions on cases.
- The clinical team works closely with their supervisors and senior clinicians on the team for support.
- Team does have group chats on Teams for routine questions.
- Team works closely together along with the coordinator team who owns end to end process on cases.
- Team handles various types of authorization and claim review requests from various markets nationwide.
- Processing clinical reviews to ensure members have the best outcomes and access to care needed.
- Help reduce provider abrasion by processing retrospective claim reviews.
Key Requirements and Technology Experience:
- Key Skills:RN ,Prior Auth ,Claims .
- Medicare knowledge, InterQual or Milliman Experience, Clinical reviews for Utilization Management or Appeals.
- Medicare Appeals Experience.
- Associate in nursing, Bachelor s in nursing or higher.
- 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, 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 .