Health Clinical Service Analyst
Gratitude IncHealth Clinical Service Analyst
Job Description
Key Skills
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Urgent Hiring for Care Management US RN Voice Sr Analyst
Location: Taguig
JOB DESCRIPTION
• Conduct UM pre-service, concurrent, retrospective, out of network, and appropriateness of
treatment setting.
• Reviews service requests to ensure compliance with applicable criteria, medical policy, and
member eligibility, benefits and contracts.
• Utilize client specific criteria sets (e.g., Milliman or InterQual), applicable client specific medical
policy and client clinical guidelines for decision making to either approve or summarize and route to
Client's nursing reviewer and/or Client's medical staff for review.
• Accurately routes cases to client medical staff for further review when a service or admission does
not meet medical necessity, place of service, or benefit criteria.
• Responsible for conducting medical management review activities which require the review of
clinical information against client specific criteria as noted above but excludes denial
determinations.
JOB QUALIFICATIONS
• Graduate of Bachelor of Science in Nursing (BSN)
• Must have at least 3 months’ work experience as a Registered Nurse in a clinical setting
• Must have an active USRN License
• Holds current and unrestricted US Registered Nurse license (state-specific RN licensure)
• Must be willing to work on a shifting schedule including graveyard shift
• Must be willing to report onsite during the training period for 3 months. Work from home after
training but must be amenable to report onsite based on client/project mandate
Role
Manager -Customer Service
Timings
Flexible (Permanent)
Industry
BPO
Work Mode
Work from office
Process
Voice
Functional Area
ITES / BPO / Customer Service
Note: Myglit doesn't charge any money from candidates. If you have been asked to pay money to get this job then report to us immediately at support@myglit.com.
Interview Tips
- Giving the VNA round?
- What are the most important skills you acquired as a Soft Skills/VNA trainer?
- How would you handle an irate customer?
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