Healthcare Professional

2 days ago


Delhi, Delhi, India Nezda Technologies Inc. Full time

Nezda Technologies Inc. is a dynamic technology firm currently seeking an experienced Clinical Nurse Case Manager to join our team.

 Salary: ₱ 50,000 - ₱68,000 per annum (with comprehensive benefits and perks).

Job Location: NCR

We are partnering with multiple organizations to fill this position, offering candidates flexibility in choosing the best fit. 

The successful candidate will have the opportunity to work directly with us, without any employment bonds.

Primary Responsibilities:

  1. Conduct UM pre-service, concurrent, retrospective, out of network, and appropriateness of treatment setting assessments.
  2. Review service requests for compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
  3. Determine the suitability of treatment settings using client-specific criteria sets (e.g., Milliman or InterQual), medical policy, and clinical guidelines.
  4. Collaborate with clients' nursing reviewers and medical staff to ensure high-quality, cost-effective care throughout the medical management process.
  5. Evaluate member access to necessary healthcare services in a cost-effective manner according to the contract.

Requirements:

  • Active and non-active USRN licenses.
  • At least one year of experience in clinical or hospital settings.


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