Health Clinical Services Senior Analyst

Gratitude Inc

530 Views

19 hours ago

0-1 Year(s)

Manila

Job Description

Key Skills

clinical experience Active USRN Mainland license

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

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