Position - Associate Consultant ( Medical / Clinical review experience )
- Work Location : Mangalore
- Shift Timings : US Shift/ Night shift
- Notice Period : Immediately to 15 days
- Budget - 12 LPA
Requirement :
BSc/MSc nursing with NCLEX certification and active US RN license (Desk side experience)
:
1. - Senior SME Skillset: Training, Data Management and reporting, Quality Tools, Descriptive Analysis, Current project Implementation
2. - Perform medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and Standard Operating procedures
3. - Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred.
4. - Good understanding of US healthcare business
5. - Knowledge of utilization management processes (preferred)
6. - Ability to understand Milliman guidelines (preferred)
7. - Knowledge of managed care, acute care, emergency room, cardiology, radiology, etc.
8. - Understanding of ICD and CPT codes