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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