Clinical Advice Specialist
2 weeks ago
About Us
We strive to make healthcare more accessible and understandable. Our team provides clinical advice and participates in audit activities to support the business and implement our clinical governance policies.
Key Responsibilities:
- Review claims for clinical appropriateness and adherence to contractual eligibility, including ICU guidelines.
- Provide consultation services to other departments, such as Ancillary Benefits Management and Products.
- Conduct clinical research for requests related to the provision of benefits outside the scope of the member's policy product.
- Clinical auditing of hospitals and other health care providers.
- Participation in medical and hospital data analysis and audit activities.
Requirements:
- MORE THAN 5 YEARS EXPERIENCE AS A REGISTERED NURSE WITH RECENT HOSPITAL EXPERIENCE IN ADULT CRITICAL CARE AND PREFERABLY SPECIAL CARE NURSERY EXPERIENCE.
- EXPERIENCE OR KNOWLEDGE OF THE RELATIONSHIP BETWEEN HOSPITALS AND HEALTH INSURANCE ORGANIZATIONS.
- COMPETENCE IN MICROSOFT OFFICE SUITE.
- ABILITY TO ASSIMILATE NEW DATA AND ASSESS THE VERACITY OF MEDICAL INFORMATION.
Benefits:
- Purpose-driven passion.
- Wellness and work-life balance.
- Collaboration and inclusivity.
- Continuous learning and growth.
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