Utilization Management Specialist Neltner Business Services

5.0 - 10.0 years

5 - 10 Lacs

Chennai

Work from Office

Role & responsibilities We are seeking a dedicated Utilization Management Specialist to join our Chennai office. In this role, you will be responsible for reviewing and analyzing clinical information to determine the medical necessity and appropriateness of healthcare services, ensuring compliance with established guidelines and policies. Your expertise will contribute to optimizing patient care and resource utilization. Key Responsibilities Conduct prior authorization, concurrent, and retrospective reviews for various healthcare services, including inpatient, outpatient, home health, and behavioral health. Apply evidence-based criteria (e.g., MCG, InterQual) to assess the necessity of medical services. Collaborate with healthcare providers, medical directors, and clinical staff to facilitate appropriate care plans and resource utilization. Maintain accurate and organized documentation of all utilization management activities. Participate in quality improvement initiatives and assist in developing clinical guidelines. Monitor and report on utilization trends to management, identifying areas for improvement. Educational qualifications and Experience : Bachelor's Degree in Nursing (BSc Nursing) or equivalent. Minimum of 2 years of clinical experience in a hospital or healthcare setting. Active and unrestricted Registered Nurse (RN) license in the United States. Familiarity with utilization management processes and guidelines (e.g., MCG, InterQual). Proficient in medical terminology, anatomy, and physiology. Strong analytical and problem-solving skills. Excellent communication skills, both written and verbal. Proficient in Microsoft Office applications. Preferred candidate profile Preferred Qualifications Experience with Medicaid, Medicare, and Managed Care programs. Previous experience in utilization review or case management. Certification in Case Management (CCM) or Accredited Case Manager (ACM) is a plus

Posted 1 month ago

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Data Scientist/Senior Data Scientist Tiger Analytics

3 - 8 years

18 - 30 Lacs

Hyderabad, Chennai, Bengaluru

Hybrid

Role & responsibilities What You'll Do: Analyse and integrate clinical and multi-omics datasets (e.g., genomics, proteomics) to extract actionable insights. Develop and validate predictive models for biomedical research and biomarker discovery. Apply Design of Experiments (DOE) and statistical methods to support research objectives. Build interactive web applications using Streamlit or R Shiny for data visualization and exploration. Ensure reproducibility, code quality, and adherence to industrialized coding best practices using Git/GitHub. Collaborate with cross-functional teams including bioinformaticians, data engineers, and clinicians. Document analysis workflows, methodologies, and results in a clear and structured manner. Communicate findings through reports, dashboards, and presentations to technical and non-technical stakeholders. Technical Skills Programming & Tools: R (Tidyverse), Python (pandas, NumPy, scikit-learn) Streamlit or R Shiny for web application development Git/GitHub for version control and code management GCP What You Need: Data Science & Modeling: Exploratory Data Analysis (EDA), Statistical Modeling, Predictive Modeling Clinical data interpretation and Omics data integration Design of Experiments (DOE), Reproducibility & Repeatability Data visualization (ggplot2, matplotlib, seaborn, etc.) You are important to us, lets stay connected! Every individual comes with a different set of skills and qualities so even if you don’t tick all the boxes for the role today, we urge you to apply as there might be a suitable/unique role for you tomorrow.We are an equal-opportunity employer. Our diverse and inclusive culture and values guide us to listen, trust, respect, and encourage people to grow the way they desire. Note: The designation will be commensurate with expertise and experience. Compensation packages are among the best in the industry.Additional Benefits: Health insurance (self & family), virtual wellness platform, and knowledge communities.

Posted 2 months ago

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