Health Clinical Services Analyst [With Active USRN License]

Gratitude Inc

1705 Views

11 hours ago

2-3 Year(s)

₱ 45 - ₱ 55K p.m

Manila

Job Description

Key Skills

US Registered Nurse

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

key skills

BS Nursing

BSN

US Registered Nurse

USRN

USRN License

Location

Taguig

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

Customer Service Executive

Timings

Rotational Shifts (Permanent)

Industry

BPO

Work Mode

Hybrid

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.

Wesley Ivan Galicia

Recruiter - Gratitude Inc

NA, philippines

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