US Registered Nurse

As an US Registered Nurse - clinical experience at Mangalore, your role overview includes performing medical necessity and clinical reviews of authorization requests, analyzing authorization requests for medical necessity, and understanding US healthcare business. Your key responsibilities will involve: - Senior SME Skillset: Training, Data Management and reporting, Quality Tools, Descriptive Analysis, New project Implementation - Perform medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and Standard Operating procedures - Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred - Good understanding of US healthcare business - Knowledge of utilization management processes (preferred) - Ability to understand Milliman guidelines (preferred) - Knowledge of managed care, acute care, emergency room, cardiology, radiology, etc. - Understanding of ICD and CPT codes Qualifications required for this role include: - BSc/MSc nursing with NCLEX certification and active US RN license - Technical Skill Set: Microsoft Word, Excel, Computer navigation, typing skills, effective communication skills, both verbal and written If you are interested in this opportunity, please share your Updated Resume with the provided details to cs.elakiyadhevi@infosys.com: - Name - Email & Mobile Number - Graduation - Date Of Birth - Post-Graduation (If applicable) - Total experience - Relevant experience - Current/Previous Company name - Current CTC - Expected CTC - Notice period - Current location Thank you, Talent Acquisition Team Infosys BPM Ltd,