Nurse Consultant

• Industry: BPO (Healthcare)
  
• Job Title: Nurse Consultant
  
• Location: Infopark KakkanadKochi
  
• Exp: min. of 18 months clinical experience mandatory
  
• Shift: Night Shift (6PM to 3AM)
  
• Salary: 30000/ to 40000/ Per Month
  
• Should have excellent fluency in English.
  

1. 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.
   
2. Supports identification and review of appropriate case types in compliance with the clinical guidelines
   
3. Promotes/supports quality effectiveness of Healthcare Services.
   
4. 
   

1. Reviews documentation and evaluates potential quality of care issues based on clinical policies and benefit determinations
   
2. Considers all documented system information as well as any additional records/data presented to develop a determination or recommendation.
   
3. Condenses complex information into a clear and precise clinical picture while working independently.
   
4. Data gathering requires navigation through multiple system applications.
   
5. Utilizes client systems to build research and enter member information.
   
6. Applies clinical guidelines in determining clinical decisions
   
7. Experience in patient management in a clinical setting is a requirement to help with clinical understanding
   
8. Accurately applies review requirements to assure case is reviewed by a practitioner with clinical expertise for the issue at hand.
   
9. Promotes communication both internally and externally to enhance effectiveness of medical management services (e.g. Claim Administrators
   
10. Plan Sponsors and 3rd party payers as well as Member Family and Healthcare Team Members respectively)
    
11. Protects the confidentiality of member information and adheres to company policies regarding
    
12. 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: Min. of 18 months clinical exp.
  
• Should have excellent fluency in English
  
• will to work in shifts / Night Shift (6PM to 3AM)
  

Benefits

• Cab (pickup & Drop)
  
• ES PF Health insurance
  
• Basket of allowances