Apply & Refer US Registered Nurse Clinical Support Analysts to get a Samsung Galaxy Tab 2!*

[accenturebpocebu]

---

Apply & Refer USRN Clinical Support Analysts. Get a Samsung Galaxy Tab 2!* (Cebu)
Responsible for collaboration with healthcare providers and members to promote quality member outcome, to optimize member benefits, and to promote effective use of resources. Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources. Works with medical directors in interpreting appropriateness of care.

• Primary duties may include, but are not limited to: Conducts pre-service, concurrent, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts. Service requests are received from facsimile
• Other responsibilities may be review and analysis of post service claims utilizing the member’s benefit contract and health plan guidelines. Completes review of pended claims post service for any of the following: Medical Necessity or Contractual Reviews
• Utilizes client specific criteria sets (e.g., Milliman or InterQual), applicable client specific medical policy and client clinical guidelines for decision making to either approve or summarize and route to Client’s nursing reviewer and/or Client’s medical staff for review
• Responsibilities include conducting any utilization or medical management review activities which require the interpretation of clinical information, but excludes denial determinations.Ensures member access to medical necessary, quality healthcare in a cost effective setting according to contract. Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process. Collaborates with providers to assess members, needs for early identification of and proactive planning for discharge planning. Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required
• Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards

Requirements

• US-Registered Nurse and an active US State license holder
• Minimum two years of formal clinical experience
• Experience in Case Management in the health industry a plus
• Willing to work on shifting schedule

Visit our Recruitment Center:
Mon-Fri, 9am – 4pm
5F Robinsons Cybergate Mall
Don Gil Garcia St., Capitol Site, Cebu City

Please bring your updated resume and a valid ID.


Refer USRN Clinical Support Analysts and get a Samsung Galaxy Tab 2 for every hired referral!*

Here’s how to refer:
1. Fill out the Candidate Referral Form & Submit it to the Recruitment Receptionist.

Or email your referral’s resume to j.m.escoto@accenture.com with subject heading: istorya_CRP_USRN_YourFullname_Contact Number

3. Get a Samsung Galaxy Tab2 for every hired referral!*

*Conditions apply.

[accenturebpocebu]

Or you can send your resume to j.m.escoto@accenture.com with subject heading: istorya-Cebu: Position Applied.

[fernolz]

mas indot ni xa i post sa job section eace: