USRN Requests for Kochi Expansion

Job description

Job Description: Essential Functions: Clinician : Works collaboratively with Regional Medical Directors to make sound, evidence based clinical decisions regarding the requested cases (treatments and procedures), performs pre-service (DME only) and retrospective clinical reviews utilizing criteria set forth by the client and Medicare (CMS-Centers for Medicare and Medicare Services) and does provider outreach via call or fax to request for clinical information or to coordinate peer to peer review if deemed required. - Responsibilities: 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 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. - Understanding of end-to-end processes and appreciation of critical parameters - Effective communication and motivational skills - Qualifications: B.Sc Nursing Graduate or Post Basic Bsc Nursing - Active India Nursing license - Active USRN license - Atleast 1 year clinical experience