Job Category: Operations

Job Description:

Essential Functions:

Clinician: Works collaboratively with Regional Medical Directors to make sound, evidence based clinical decisions regarding the requested cases (treatments and procedures), performs pre-service (DME only) and retrospective clinical reviews utilizing criteria set forth by the client and Medicare (CMS-Centers for Medicare and Medicare Services) and does provider outreach via call or fax to request for clinical information or to coordinate peer to peer review if deemed required.

Responsibilities:

- Solid customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members.




- Computer literacy to navigate through internal/external computer systems, including Excel and Microsoft Word.
- Ability to effectively participate in a multi-disciplinary team including internal and external participants.
- Familiarity with basic medical terminology and concepts used in care management.
- Effective communication, telephonic and organization skills.
- Understanding of end-to-end processes and appreciation of critical parameters
- Effective communication and motivational skills

Qualifications:

- B.Sc Nursing Graduate or Post Basic Bsc Nursing
- Active India Nursing license
- Active USRN license
- Atleast 1 year clinical experience

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