Provide comprehensive clinical review of complaints and appeals filed by providers with the use of appropriate resources and guidelines to ensure cost effective delivery of health services.
Supports identification and review of appropriate case types in compliance with the clinical guidelines.
Promotes/supports quality effectiveness of Healthcare Services.
Accurately applies review requirements to assure case is reviewed by a practitioner with clinical expertise for the issue at hand.
Ability to understand and interpret clinical laboratory results and familiarity with clinical conditions and its management is required.
Requirements
Qualification: Bachelor of Science in Nursing.
Experience: Minimum of 18 months clinical exp.
Should have excellent fluency in English.
Will to work in shifts / Night Shift (6PM to 3AM).