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USRN Voice Sr Analyst

Job Location: Cebu

Job Number: J1596

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- Job description

Conducts pre-service, concurrent/continued stay, 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 may be from inbound calls and facsimile. Outbound calls to the provider may be required to gather additional information that may be needed.
• US Registered Nurse with an active/inactive US State license • At least 3 months formal clinical experience • Experience in Case Management in the health industry a plus • Willing to work on shifting schedule • Excellent communication skills


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