• The US Registered Nurse Senior Analyst is responsible to collaborate with healthcare providers and members to promote quality member outcomes, 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 may steer members to appropriate providers, programs or community resources.
• Active, unrestricted United State (US) registered nurse license
• Active, unrestricted Regional Philippine registered nurse license
• Minimum of three 3 months (equivalent to 480 hrs) of prior working experience as a registered nurse in a clinical setting and providing direct patient care is required
• Clinical setting includes inpatient hospital, outpatient hospital, dialysis center, ambulatory, or primary care clinic
• With at least 2yrs or more/1yr sup exp/individual contributor