Pyramid Consulting (Travel)

Cincinnati

Job Title: RN PCULocation: Cincinnati, OH 45219Shift: Nights, 7 PM - 7 AM (Rotating Weekends)Duration: 13 Weeks Job Summary:<ul><li>The Progressive Care Unit (PCU) is a dynamic, fast-paced unit specializing in the care of adult patients requiring intermediate-level nursing care following medical procedures, surgical interventions, or diagnostic treatments. This unit serves as a vital bridge between outpatient and inpatient settings, providing close monitoring and timely interventions for patients with evolving clinical needs.</li><li>Our PCU primarily focuses on short-stay patients-those expected to be discharged within 24 hours-and individuals admitted with a diagnosis of chest pain, recovering from procedures such as cardiac catheterization, endoscopic interventions, electrophysiology studies, interventional radiology, or minor surgeries.</li><li>The team is skilled in managing patients with cardiac monitoring needs, moderate sedation recovery, and early ambulation goals, ensuring rapid recovery and discharge planning.</li></ul> Job Responsibilities:<ul><li>Telemetry monitoring and advanced cardiac support.</li><li>Chest Pain care with expedited testing and follow up.</li><li>Post-procedural care for moderate to lower acuity patients.</li><li>Patient-centered, goal-directed care focused on rapid recovery.</li><li>Multidisciplinary collaboration with procedural departments and care management teams.</li><li>Strong focus on patient safety, throughput, and satisfaction.</li></ul> Required Skills &amp; Experience:<ul><li>The RN demonstrates the knowledge, abilities, and skills to provide age and culturally specific patient care and education.</li><li>The RN effectively communicates with peers, utilizes appropriate channels of communication and maintains absolute confidentiality.</li><li>The RN maintains competence and demonstrates evidence of continuing professional growth.</li><li>The RN demonstrates the ability to accept and implement change and the ability to work in a culturally diverse setting.</li></ul> Education:<ul><li>Diploma of Nursing.</li></ul> Required Certifications &amp; Licensure:<ul><li>Ohio RN license or Compact.</li><li>BLS (American Heart Assoc.)</li><li>ACLS (American Heart Assoc.)</li></ul>

Local Contract RN - PCU - Progressive Care Unit

Philadelphia

Job Title: Care Management Coordinator RNLocation: RemoteShift: DaysDuration: 13 Weeks Job Summary<ul><li>The Care Management Coordinator primary responsibility is to evaluate a member’s clinical condition through the review of medical records (including medical history and treatment records) to determine the medical necessity for patient’s services based on advanced knowledge and independent analysis of those medical records and application of appropriate medical necessity criteria.</li><li>If necessary, the Care Management Coordinator directly interact with providers to obtain additional clinical information.</li><li>The Care Management Coordinator has the authority to commit the company financially by independently authorizing services determined to be medically necessary based on their personal review.</li><li>For those cases that do not meet established criteria, the Care Management Coordinator provides relevant information regarding members medical condition to the Medical Director for their further review and evaluation.</li><li>The Care Management Coordinator has the authority to approve but cannot deny the care for patients.  The Care Management Coordinator is also responsible for maintaining regulatory compliance with federal, state and accreditation regulations.</li><li>Additionally, the Care Management Coordinator acts a patient advocate and a resource for members when accessing and navigating the health care system.</li></ul> Key Responsibilities<ul><li>Applies critical thinking and judgement skills based on advanced medical knowledge to cases utilizing specified resources and guidelines to make case determination.  Utilizes resources such as; InterQual, Care Management Policy, Medical Policy and Electronic Desk References to determine the medical appropriateness of the proposed plan.</li><li>Utilizes the medical criteria of InterQual and/or Medical Policy to establish the need for inpatient, continued stay and length of stay, procedures and ancillary services.</li><li>Note:  InterQual - It is the policy of the Medical Affairs Utilization Management (UM) Department to use InterQual (IQ) criteria for the case review process when required. IQ criteria are objective clinical statements that assist in determining the medical appropriateness of a proposed intervention which is a combination of evidence-based standards of care, current practices, and consensus from licensed specialists and/or primary care physicians. IQ criteria are used as a screening tool to support a clinical rationale for decision making.</li><li>Contacts servicing providers regarding treatment plans/plan of care and clarifies medical need for services.</li><li>Reviews treatment plans/plan of care with provider for requested services/procedures, inpatient admissions or continued stay, clarifying medical information with provider if needed.</li><li>Identifies and refers cases in which the plan of care/services are not meeting established criteria to the Medical Director for further evaluation determination.</li><li>Performs early identification of members to evaluate discharge planning needs.</li><li>Collaborates with case management staff or physician to determine alternative setting at times and provide support to facilitate discharge to the most appropriate setting.</li><li>Reports potential utilization issues or trends to designated manager and recommendations for improvement.</li><li>Appropriately refers cases to the Quality Management Department and/or Care Management and Coordination Manager when indicated to include delays in care.</li><li>Appropriately refers cases to Case and Disease Management.</li><li>Ensures request is covered within the member’s benefit plan.   </li><li>Ensures utilization decisions are compliant with state, federal and accreditation regulations.</li><li>Meets or exceeds regulatory turnaround time and departmental productivity goals when processing referral/authorization requests.</li><li>Ensures that all key functions are documented via Care Management and Coordination Policy.</li><li>Maintains the integrity of the system information by timely, accurate data entry.</li><li>Performs additional duties assigned.</li></ul> Qualifications:<ul><li>Active PA Licensed RN</li><li>BSN Preferred</li><li>Minimum of three (3) years of Medical/Surgical experience.</li><li>Previous Acute Hospital Utilization management/ IQ experience</li></ul> Knowledge, &amp; Skills<ul><li>Exceptional communication, problem solving, and interpersonal skills.</li><li>Action oriented with strong ability to set priorities and obtain results.</li><li>Team Player - builds team spirit and interdepartmental rapport, using effective problem solving and motivational strategy.</li><li>Open to change, comfortable with new ideas and methods; creates and acts on new opportunities; is flexible and adaptable.</li><li>Embrace the diversity of our workforce and show respect for our colleagues internally and externally.</li><li>Excellent organizational planning and prioritizing skills.</li><li>Ability to effectively utilize time management.</li><li>Oriented in current trends of medical practice.</li><li>Proficiency utilizing Microsoft Word, Outlook, Excel, SharePoint, and Adobe programs. Ability to learn new systems as technology advances.</li></ul>

Philadelphia PA Pennsylvania 1 This is a remote position, if you reside in the tri-state area (NJ, DE or PA) feel free to get in touch and we can discuss about the role in detail.

Local Contract RN - Care Manager

Job DescriptionPart Time UM RN with NICU experienceRN license required or Nurse Licensure Compact that includes Pennsylvania for Registered Nurses licensed in another state and maintain their license in the name under which they are currently working. Permanent schedule - This position will be 5 full days over a two week period - 2 days (Mon &amp; Tues) the 1st week, and 3 days (Wed, Thurs, &amp; Fri) the 2nd week  GENERAL SUMMARY: Under the direction of a designated Manager o, performs telephonic review of hospital admissions, recommending alternative levels of care when appropriate. Works to add value to healthcare by encouraging efficient and high quality use of the healthcare delivery system. Promotes timely and dynamic discharge planning to facilitate early discharge and refers cases to Case Management when indicated. Efficiently collaborates with the hospital utilization review department, attending physicians and members/families as appropriate. DUTIES AND RESPONSIBILITIES: Performs telephonic utilization management for inpatient admissions . Using the medical software criteria, establish the need for inpatient, continued stay and length of stay. Directs the delivery of care to the most appropriate setting, while maintaining quality. Contacts attending physicians regarding treatment plans/plan of care and clarifies medical need for inpatient stay or continued inpatient care Identifies inpatient admissions no longer meeting criteria and refers care to plan Medical Directors for evaluation. Presents cases to Medical Directors that do not meet established criteria and provides pertinent information regarding member?s medical condition and the potential home care needs. Performs early identification of hospitalized members to evaluate discharge planning needs. Collaborates with hospital case management staff, physician and family to determine alternative setting at times and provide support to facilitate discharge to the most appropriate setting. Identifies and refers cases for case management and disease management. Identifies quality of care issues including delays in care. Appropriately refers cases to the Quality Management Department and/or Care Management and Coordination Supervisor when indicated. Maintains the integrity of the system information by timely, accurate data entry. Utilization decisions are in compliance with state, federal and accreditation regulations. Works to build relations with all providers and provides exceptional customer service. Reports potential utilization issues or trends to designated supervisor and recommendations for improvement. Participates in the process of educating providers on managed care. Performs additional related duties as assigned ?KNOWLEDGE, SKILLS AND ABILITIES REQUIRED: Education and experience: Registered NurseBS preferred. Minimum of three (3) years of acute care clinical experience in a hospital or other health care setting. Prior discharge planning and/or utilization management experience is required. Skills: Exceptional communication skills on all levels Proficiency in using computerized applications Problem solving ability Organized, demonstrated excellent team management skills Team Player

Philadelphia PA Pennsylvania 1 Part Time UM RN with NICU experience
This position is remote - Full-time ONLY during training - 2-3 weeks, Must be available M-F for the training period.

Local Contract RN - Utilization Review

Job SummaryThe Care Management Coordinator primary responsibility is to evaluate a member’s clinical condition through the review of medical records (including medical history and treatment records) to determine the medical necessity for patient’s services based on advanced knowledge and independent analysis of those medical records and application of appropriate medical necessity criteria.  If necessary, the Care Management Coordinator directly interact with providers to obtain additional clinical information.  The Care Management Coordinator has the authority to commit the company financially by independently authorizing services determined to be medically necessary based on their personal review.  For those cases that do not meet established criteria, the Care Management Coordinator provides relevant information regarding members medical condition to the Medical Director for their further review and evaluation.  The Care Management Coordinator has the authority to approve but cannot deny the care for patients.  The Care Management Coordinator is also responsible for maintaining regulatory compliance with federal, state and accreditation regulations.  Additionally, the Care Management Coordinator acts a patient advocate and a resource for members when accessing and navigating the health care system. Key Responsibilities<ul><li>Applies critical thinking and judgement skills based on advanced medical knowledge to cases utilizing specified resources and guidelines to make case determination.  Utilizes resources such as; InterQual, Care Management Policy, Medical Policy and Electronic Desk References to determine the medical appropriateness of the proposed plan.</li><li>Utilizes the medical criteria of InterQual and/or Medical Policy to establish the need for inpatient, continued stay and length of stay, procedures and ancillary services.</li><li>Note:  InterQual - It is the policy of the Medical Affairs Utilization Management (UM) Department to use InterQual (IQ) criteria for the case review process when required. IQ criteria are objective clinical statements that assist in determining the medical appropriateness of a proposed intervention which is a combination of evidence-based standards of care, current practices, and consensus from licensed specialists and/or primary care physicians. IQ criteria are used as a screening tool to support a clinical rationale for decision making.</li><li>Contacts servicing providers regarding treatment plans/plan of care and clarifies medical need for services.</li><li>Reviews treatment plans/plan of care with provider for requested services/procedures,  inpatient admissions or continued stay, clarifying medical information with provider if needed.</li><li>Identifies and refers cases in which the plan of care/services are not meeting established criteria to the Medical Director for further evaluation determination.</li><li>Performs early identification of members to evaluate discharge planning needs.</li><li>Collaborates with case management staff or physician to determine alternative setting at times and provide support to facilitate discharge to the most appropriate setting.</li><li>Reports potential utilization issues or trends to designated manager and recommendations for improvement.</li><li>Appropriately refers cases to the Quality Management Department and/or Care Management and Coordination Manager when indicated to include delays in care.</li><li>Appropriately refers cases to Case and Disease Management.</li><li>Ensures request is covered within the member’s benefit plan.   </li><li>Ensures utilization decisions are compliant with state, federal and accreditation regulations.</li><li>Meets or exceeds regulatory turnaround time and departmental productivity goals when processing referral/authorization requests.</li><li>Ensures that all key functions are documented via Care Management and Coordination Policy.</li><li>Maintains the integrity of the system information by timely, accurate data entry.</li></ul>Performs additional duties assigned.QualificationsEducationActive PA Licensed RNBSN Preferred Required ExperienceMinimum of three (3) years of Medical/Surgical experience.  Previous Acute Hospital Utilization management/ IQ experience Knowledge, &amp; Skills<ul><li>Exceptional communication, problem solving, and interpersonal skills.</li><li>Action oriented with strong ability to set priorities and obtain results.</li><li>Team Player - builds team spirit and interdepartmental rapport, using effective problem solving and motivational strategy.</li><li>Open to change, comfortable with new ideas and methods; creates and acts on new opportunities; is flexible and adaptable.</li><li>Embrace the diversity of our workforce and show respect for our colleagues internally and externally.</li><li>Excellent organizational planning and prioritizing skills.</li><li>Ability to effectively utilize time management.</li><li>Oriented in current trends of medical practice.</li><li>Proficiency utilizing Microsoft Word, Outlook, Excel, SharePoint, and Adobe programs. Ability to learn new systems as technology advances.</li></ul>

Philadelphia PA Pennsylvania 1 Position is remote - candidate must reside in the tri-state area (PA, DE, NJ)

Must have an active PA license or a Nurse Licensure Compact to include PA.

Pyramid Consulting (Travel)

Pyramid Consulting (Travel)

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Pyramid Consulting (Travel) jobs

Local Contract Nurse RN - PCU - Progressive Care Unit

Local Contract Nurse RN - Care Manager

Local Contract Nurse RN - Utilization Review

Local Contract Nurse RN - Utilization Review