Associate Consultant

Infosys BPM Ltd.; Mangaluru; Sur place; INR 450 000 - 750 000; Plein temps

Résumé du poste

Infosys BPM Ltd. is seeking an NCLEX-certified nurse with an active US RN license and 5+ years of clinical experience to join our healthcare operations team in India. The role combines nursing expertise with data-driven processes to support medical necessity reviews.

You will lead training, data management and reporting efforts, apply Descriptive Analysis, and participate in new project implementation. Strong communication and analytical skills are essential to collaborate with clients and

Qualifications

• Nursing qualification with NCLEX certification and active US RN license.
• 5+ years of clinical experience in healthcare.
• Experience with utilization management and US healthcare processes.

Responsabilités

• Perform medical necessity and clinical reviews of authorization requests.
• Analyze requests to determine medical necessity per regulations.
• Understand US healthcare business and ICD/CPT codes.
• Support data management, reporting and quality tools.
• Collaborate with clients and refine data-driven deliverables.
• Identify improvement areas and suggest technology solutions.

Connaissances

Training

Data management

Reporting

Quality tools

Descriptive analysis

New project implementation

Effective communication

Typing skills

Problem solving

Logical thinking

Client collaboration

Formation

NCLEX Certification

US RN License

Graduate

Outils

Microsoft Word

Microsoft Excel

Description du poste

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