Nurse Consultant
Job Summary
Nurse Consultant
Industry: BPO (Healthcare)
Location: Infopark Kakkanad Kochi Qualification: BSC Nursing/ Post BSC (GNM not considered) Experience: Minimum 18 months of clinical experience mandatory
Shift: 6PM to 3AM (Monday-Friday)
Salary: 35000/- to 40000/- (CTC) Per Month
Should have excellent fluency in English. * NCLEX training and examination support will be fully sponsored by the company at no cost to the candidate.
Responsibilities
- Review and analyze medical claims provider appeals and dispute cases within the US healthcare insurance process.
- Evaluate clinical documentation medical records and supporting evidence to determine medical necessity and appropriateness of care.
- Assess healthcare claims using clinical guidelines payer policies and utilization management criteria.
- Process appeals grievances pre-authorizations and utilization review cases accurately and within defined timelines.
- Collaborate with physicians healthcare providers and internal teams to gather and review additional clinical information.
- Ensure compliance with US healthcare regulations insurance policies and quality standards.
Required Skills:
BSC Nursing18 months of clinical experience
Required Education:
BSC Nursing