Associate Consultant

Job Description
BSc/MSc nursing with NCLEX certification and active US RN license
NCLEX Certified Nurse with 5+ years of clinical experience


Roles & Responsibilities
Senior SME Skillset: Training, Data Management and reporting, Quality Tools, Descriptive Analysis, New project Implementation
- Perform medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and Standard Operating procedures
- Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred.
- Good understanding of US healthcare business
- Knowledge of utilization management processes (preferred)
- Ability to understand Milliman guidelines (preferred)
- Knowledge of managed care, acute care, emergency room, cardiology, radiology, etc
- Understanding of ICD and CPT codes


Technical Requirement
Primary skills: Operations->Clinical Data Management
Microsoft Word, Excel, Computer navigation, typing skills, effective communication skills, both verbal and written


Additional Responsibility

Ability to work with clients to identify business challenges and contribute to client deliverables by refining, analyzing, and structuring relevant data

Awareness of latest technologies and trends

Logical thinking and problem solving skills along with an ability to collaborate

Ability to assess the current processes, identify improvement areas and suggest the technology solutions

One or two industry domain knowledge


Educational Requirement
Graduate


Preferred Skills
Operations->Clinical Data Management


Service Line
BPO Service Line