Health Clinical Service Analyst

Gratitude Inc

638 Views

19 hours ago

1-2 Year(s)

Manila

Job Description

Key Skills

Communication Medical Assistance Medical technology Nursing medical coding US Registered Nurse clinical nurse Medical background

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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.

Prachi Singh

Recruiter - Gratitude Inc

NA, india

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