SME US Healthcare Clinical Review & Utilization Mgt NCLEX/USRN Qualifi

White Horse Manpower Consultancy; Mangaluru; On-site; INR 500,000 - 900,000; Full time

Benefits offered by this job

Plus Incentives and Bonuses

Job summary

White Horse Manpower Consultancy in India is seeking a clinician to conduct medical necessity reviews for healthcare authorization requests, applying Utilization Management processes and Milliman Care Guidelines.

You will assess clinical appropriateness of services, support training and quality initiatives, and contribute SME-level expertise to US managed care operations. Incentives and bonuses are offered.

Qualifications

• Experience applying Utilization Management processes and Milliman Care Guidelines in clinical reviews.
• Ability to share knowledge and support quality management initiatives at SME level.
• Understanding of US healthcare operations and managed care.

Responsibilities

• Conduct medical necessity clinical reviews of healthcare authorization requests.
• Assess the clinical appropriateness of requested services using clinical knowledge.

Skills

UM processes

MCG guidelines

SME-level expertise

Job description

Conduct medical necessity clinical reviews of healthcare authorization requests in accordance with regulatory requirements, established guidelines, SOPs
Assess the clinical appropriateness of requested healthcare services using clinical knowledge

Required Candidate profile

• Apply Utilization Mgt (UM) processes Milliman Care Guidelines (MCG) in clinical reviews
• Support training, knowledge sharing, quality mgt, SME‑level
• Understanding of US healthcare ops managed care

Perks and benefits

• Plus Incentives and Bonuses