Sr. Clinical Analyst

Lancesoft APAC; Makati; Hybrid; PHP 1,339,000 - 1,674,000; Full time

Job summary

Lancesoft APAC in Makati, Philippines seeks a Sr. Clinical Analyst to review and evaluate medical records, providing expert determinations for requested services.

The role supports utilization management across care, disease, quality, and pharmacy management, with clinical education responsibilities. The position requires an Active Physician PRC license and residency in Internal Medicine, Family Medicine, or Medical Sub specialties, plus strong Microsoft Office skills.

Qualifications

• Active Physician PRC license required.
• Completed residency in Internal Medicine, Family Medicine or Medical Subspecialties.
• Proficient with Microsoft Office applications.
• Excellent communication, collaboration, problem-solving and conflict-resolution skills.
• Results-driven with ownership of initiatives and cross-functional teamwork.

Responsibilities

• Review and evaluate submitted medical records to provide expert medical determinations on requested services.
• Perform utilization management activities and contribute to care/disease management, quality, pharmacy management, and clinical education.
• Ensure all clinical decisions align with regulatory, CMS policies and clinical guidelines.
• Act as a clinical escalation resource and collaborate with nursing teams across clinical functions.
• Progress to SME, trainer, and auditor roles for clinical staff and support cross-functional projects.

Skills

Communication

Collaboration

Problem-solving

Conflict resolution

Ownership

Education

Residency: Internal Medicine

Residency: Family Medicine

Residency: Medical Subspecialties

Active Physician PRC license

Tools

Microsoft Office

Job description

Sr. Clinical Analyst

Review and evaluate submitted medical records, synthesizing complex hospital-based clinical scenarios to provide expert medical determinations on requested services.-based clinical scenarios to provide expert medical determinations on requested
Perform utilization management activities, with opportunities to contribute to care management, disease management, quality management, pharmacy management, post service reviews, and clinical education.-service reviews, and clinical
Ensure all clinical decisions align with regulatory and compliance requirements, supported by national clinical guidelines, CMS policies and determinations, and trusted clinical reference sources.
Collaborate closely with nursing teams through regular clinical discussions, providing guidance and medical expertise across multiple clinical functions.
Maintain autonomous responsibility for clinical accuracy, quality, and outcomes for a large clinical workforce supporting utilization review, care/disease management, and pharmacy management.
Act as a clinical escalation resource in production environments.
With experience, progress to serve as subject matter experts, trainers, and auditors for clinical staff.
Opportunities to support operational initiatives, clinical data analysis, and participation in cross functional projects that enhance performance, efficiency, and patient outcomes.-functional projects that enhance performance, efficiency, and patient

Active Physician PRC license

Completed residency training in one of the following specialties:

• Internal Medicine
• Family Medicine
• Medical Subspecialties

Strong proficiency with Microsoft Office applications

Excellent communication, collaboration, problem-solving, and conflict-resolution skills-solving, and conflict-resolution

Results driven mindset with the ability to take ownership of initiatives and work effectively across cross functional teams-driven mindset with the ability to take ownership of initiatives and work effectively across cross-functional

Ability to thrive in a fast paced, dynamic, and team oriented environment-paced, dynamic, and team-oriented

27

Makati

Hybrid (10-12 RTOs monthly); Graveyard shift (7-10 PM start of shift)

PHP 120,000 - PHP 150,000 Basic Salary + PHP 3,600 OGA Allowance

HRI > Assessment > L1 Domain > L2 Domain > L3 Domain (with the Medical/Clinical Ops VP; could be F2F)

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