DE033658-Health Clinical Svcs Specialist

• ONLY THOSE APPLICANTS WHO ALREADY HAVE THE RIGHT TO LIVE AND WORK IN THIS COUNTRY ARE ELIGIBLE TO APPLY FOR THIS ROLE--- POSITION TITLE: Health Clinical Svcs Specialist WORK SETUP: Return to Office RESPONSIBILITIES:
• Grievance and 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.
• Need to conduct written communication assessments OTHERS: Project Shift Schedule: Rotation Project Rest Day: Rotation Project/Team Location: Taguig Uptown Bonifacio Tower 3

SKILL AND QUALIFICATIONS

• Bachelor of Science Nursing (BSN) degree or General Nursing & Midwifery (GNM) Diploma or Basic Bachelor of Science (BSC) in Nursing degree or Associate Nursing Degree or Nursing Diploma
• Holds current and unrestricted US Registered Nurse license
• 3 months clinical experience (480 hours of working experience as a RN)
• Work experience as an active RN license and providing direct patient care
• Clinical setting includes inpatient hospital, outpatient hospital or community clinic
• No state license required (doability will be revisited if there's a specific state of RN license needed)
• With at least 3-month UM experience
• With Supervisory experience Flex:
• Open to candidates (without UM experience) with Appeals experience