Nurse Level 1

2 weeks ago


Bengaluru, India Advent global solutions PVT.LTD Full time

**JOB DESCRIPTION**

**Job Group **Healthcare

**Family Name **Care Management

**Job Title **Nurse Level 1

**Family Summary/Mission**

Provide comprehensive healthcare management to facilitate delivery of appropriate quality healthcare, promote cost effective outcomes and improve program/operational efficiency involving clinical issues.

**Position Summary/Mission**
- Supports comprehensive coordination of medical services including intake, screening
and referrals to Aetna Medical Services Programs.
- Promotes/supports quality effectiveness of Healthcare Services.

**Fundamental Components & Physical Requirements **_**(include but are not limited to)**_

**Note:

- denotes essential functions**
- **Member Identification**
- Performs intake of calls from members or providers regarding services via telephone,
fax, EDI (*)
- Utilizes eTUMS and other Aetna system to build, research and enter member
information (*)
- Screens requests for appropriate referral to medical services staff (*)
- Approve services that do not require a medical review in accordance with the benefit
plan (*)
- Performs non-medical research including eligibility verification, COB, and benefits
verification (*)
- **Documentation and Communication**
- Maintains accurate and complete documentation of required information that meets
risk management, regulatory, and accreditation requirements (*)
- Promotes communication, both internally and externally to enhance effectiveness of
medical management services (e.g., Claim Administrators, Plan Sponsors, and 3rd party
payers as well as Member, Family, and Healthcare Team Members respectively)
- Protects confidentiality of member information and adheres to Aetna policies regarding
confidentiality (*)
- Communicate with Aetna Case Managers, when processing transactions for members
active in this Program (*)
- Supports the administration of the precertification process in compliance with various
laws and regulations, URAQ and/or NCQA standards, where applicable, while adhering
to Aetna policy and procedures (*)
- **Sedentary work involving significant periods of sitting, talking, hearing and**
**keying.**
- **Work requires visual acuity to perform close inspection of written and computer**
**generated documents as well as a PC monitor.**
- **Working environment includes typical office conditions.**

**ADDITIONAL INFORMATION (situational competencies, skills, work location requirements, etc.)**

Strong 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 in order 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

**Salary**: ₹200,000.00 - ₹500,000.00 per year

**Benefits**:

- Health insurance
- Work from home

Schedule:

- Day shift
- Monday to Friday
- US shift

Ability to commute/relocate:

- Bangalore, Karnataka: Reliably commute or planning to relocate before starting work (required)

**Experience**:

- total work: 1 year (preferred)



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