Utilization Management US Registered Nurse Senior Analyst

Career Opportunity: Utilization Management US Registered Nurse Senior Analyst

Grievance & Appeals

Creates complete appeal records for external appeal reviews, using standardized Independent Review Entity (IRE) forms and including all required documentation.

Creates a detailed case summary in narrative format for each appeal.

Submits cases as directed for each applicable geographic region.

Presents verbal and written case summaries to client's Grievance Team and client Medical Directors.

Completes assignments within client-designated turnaround times

What we're looking for:

• Bachelor of Science Nursing (BSN) degree or General Nursing & Midwifery (GNM) Diplomaor Basic Bachelor of Science (BSC) in Nursing degree or Associate Nursing Degree or Nursing Diploma
• Holds current and unrestricted US Registered Nurse license
• Minimum 6 months Utilization Management experience
• At least 3 months clinical experience (480 hours) as an RN
• Active RN license with direct patient care experience
• Clinical setting: inpatient hospital, outpatient hospital, or community clinic

Work Location: Uptown Bonifacio, Taguig

Apply Now!

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