Health Clinical Services Senior Analyst
Gratitude IncHealth Clinical Services Senior Analyst
Job Description
Key Skills
1 candidate(s) have already applied for this Job. Apply now
Gratitude Inc. is a leading professional HR Tech Recruitment firm specializing in recruiting permanent, contract, and temporary positions for the world's top companies. Our base is in India, Philippines, Malaysia, Kenya, Nigeria, Singapore, Vietnam, Thailand, and USA for now. We are a Direct Sourcing Partner Company of the different top BPOs offshore and onshore.
We are urgently hiring for Health Clinical Services Senior Analyst for our partner BPO company located in Taguig.
Position: Health Clinical Services Senior Analyst
Location: Taguig
Salary: Up to 32K (Negotiable)
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 the 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 benefits criteria.
- Responsible for conducting medical management review activities that 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.
To apply, please submit your updated resume on this post and answer the pre-screening questions or apply directly through the application link below:
https://myglit.com/lateral/cref/a092c251a4
Further details will be discussed once invited for an interview.
Our recruitment team will reach out to you via WhatsApp or direct call once shortlisted.
APPLY NOW!
Role
Customer Service Executive
Timings
Night Shift (Permanent)
Industry
BPO
Work Mode
Work from office
Process
Semi-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.
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