Health Clinical Services Analyst or Senior Analyst [With Active USRN License]

Gratitude Inc

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20 hours ago

0-1 Year(s)

Taguig

Job Description

Key Skills

USRN US Registered Nurse USRN License BS Nursing BSN

4 candidate(s) have already applied for this Job. Apply now

Position: Health Clinical Services Senior Analyst

Location: Taguig

Salary Open Budget [Based on Experience]

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

NON-BPO

Timings

Rotational Shifts (Permanent)

Industry

BPO

Work Mode

Process

Non-Voice

Functional Area

NON-BPO

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