Associate Consultant

4 days ago


Mangalore, Karnataka, India Infosys Full time ₹ 12,00,000 - ₹ 36,00,000 per year

Job Description:BSc MSc nursing with NCLEX certification and active US RN licenseNCLEX Certified Nurse with 5 years of clinical experienceKey Responsibilities:Senior SME Skillset Training Data Management and reporting Quality Tools Descriptive Analysis New project ImplementationPerform medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and Standard Operating proceduresClinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferredGood understanding of US healthcare businessKnowledge of utilization management processes preferredAbility to understand Milliman guidelines preferredKnowledge of managed care acute care emergency room cardiology radiology etcUnderstanding of ICD and CPT codesTechnical Requirements:Primary skills Operations Clinical Data ManagementMicrosoft Word Excel Computer navigation typing skills effective communication skills both verbal and writtenPreferred Skills:Operations->Clinical Data Management


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