Health Clinical Services Analyst
Gratitude IncHealth Clinical Services Analyst
Job Description
Key Skills
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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 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
Role
NON-BPO
Timings
Flexible (Permanent)
Industry
NON-BPO
Work Mode
NA
Process
Non-Voice
Functional Area
NON-BPO
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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