Job Opportunity: US Registered Nurse

We are hiring a US Registered Nurse for a agile healthcare organization that values clinical expertise and the delivery of quality care. In this role, you will play a pivotal part in ensuring that healthcare services and benefits are appropriately provided to members, leveraging your clinical experience and skills.

Job Title: US Registered Nurse

Location: Mangalore

As a US Registered Nurse, you will be responsible for collaborating with providers, members, and internal teams to assess, plan, implement, and evaluate healthcare services. Your key responsibilities include:
- Performing medical necessity and clinical reviews of authorization requests to ensure the appropriateness of care in alignment with regulatory guidelines and Standard Operating Procedures.
- Analyzing authorization requests and determining the medical necessity of services.
- Responding to provider and member correspondence regarding medical determinations.
- Reviewing and interpreting member contracts and claims, ensuring accurate and timely medical reviews.




- Using your clinical knowledge to provide clear and accurate explanations of findings to members, providers, and physicians.
- Utilizing Milliman guidelines for medical necessity reviews (preferred).
- Efficiently using Microsoft Word and Excel, as well as health insurance databases to manage claims and communications.

Desired Profile:
- Education: BSc/MSc in Nursing.
- Certification: NCLEX certification with an active US RN license.
- Experience: 1-3 years of clinical experience preferred, with a good understanding of US healthcare and medical review processes.
- Skills:
- Knowledge of utilization management processes (preferred).
- Strong understanding of ICD and CPT codes.
- Ability to analyze medical necessity and authorization requests.
- Proficiency in Microsoft Word, Excel, and health insurance databases.
- Excellent verbal and written communication skills, with the ability to communicate com

📌 Us Registered Nurse (Bengaluru)
🏢 Clini launch Business solutions
📍 Bengaluru