What are the responsibilities and job description for the RN Case Manager – Utilization Review position at Pyramid Consulting, Inc?
Immediate need for a talented RN Case Manager – Utilization Review - Onsite-Santa Clara, CA. This is a 03 months contract opportunity with long-term potential and is located in U.S(Remote). Please review the job description below and contact me ASAP if you are interested.
Job ID: 26-04512
Pay Range: $75 - $90/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:
- Schedule: 8:00 AM – 4:30 PM
- 5 days/week including every other weekend (Saturday & Sunday)
- Headcount: 2 Travelers
- Perform inpatient concurrent and continued stay reviews
- Apply InterQual or MCG criteria for medical necessity and level-of-care decisions
- Collaborate with hospital case managers and interdisciplinary teams
- Participate in discharge planning coordination
- Manage denials, authorizations, and payer communications
- Ensure compliance with CMS and regulatory standards
Key Requirements and Technology Experience:
- Active California RN License (Required prior to start)
- 2 years of inpatient acute care case management or utilization review experience
- Experience with InterQual or MCG
- Strong knowledge of Medicare / CMS guidelines
- Acute hospital background required
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.
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Salary : $75 - $90