Hiring Utilization management processes with USRN / NClex - Mangalore

Infosys BPM; Mangaluru; On-site; INR 900,000 - 1,400,000; Full time

Job summary

Infosys BPM Ltd. in Mangalore (Work from Office) seeks an Associate Consultant with 5-8 years of nursing experience and active US RN license (NCLEX). The role emphasizes training, data management and reporting, and medical necessity reviews in line with SOPs.

You will contribute to clinical reviews, apply Milliman guidelines, and work within US healthcare processes. Night US shift is part of the schedule.

Qualifications

• Qualified nursing degree with NCLEX and active US RN license.
• Desk-side experience in US healthcare domain preferred.
• 5-8 years of relevant experience in healthcare operations.

Responsibilities

• Train, manage data and generate reports for governance.
• Perform medical necessity reviews per SOPs and guidelines.
• Analyze authorization requests for medical necessity.
• Understand US healthcare business and utilization processes.
• Familiarity with ICD/CPT codes and Milliman guidelines is a plus.

Skills

Training & data management

Descriptive analysis

Quality tools

Reporting

New project implementation

Education

BSc/MSc Nursing with NCLEX and US RN license

Tools

Microsoft Word

Excel

Typing

Job description

Designation: Associate Consultant

Job Level: JL 4B

Work location: Mangalore (Work from Office)

Exp: 5-8 years

Notice Period: Immediate to 15 Days

Shift Timings: Night Shift(US Shift)

Qualification: BSc/MSc nursing with NCLEX certification and active US RN license (Desk side experience)

Job Description:

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

Technical Skill Set: Microsoft Word, Excel, Computer navigation, typing skills, effective communication skills, both verbal and written