Health Clinical Svcs Specialist

---ONLY THOSE APPLICANTS WHO ALREADY HAVE THE RIGHT TO LIVE AND WORK IN THIS COUNTRY ARE ELIGIBLE TO APPLY FOR THIS ROLE--- POSITION TITLE: Health Clinical Svcs Specialist WORK SETUP: Return to Office RESPONSIBILITIES: • Grievance and Appeals • Creates complete appeal records for external appeal reviews, using standardized Independent Review Entity (IRE) forms and including all required documentation. • Creates a detailed case summary in narrative format for each appeal. • Submits cases as directed for each applicable geographic region. • Presents verbal and written case summaries to client’s Grievance Team and client Medical Directors. • Completes assignments within client-designated turnaround times. • Need to conduct written communication assessments OTHERS: Project Shift Schedule: Rotation Project Rest Day: Rotation Project/Team Location: Taguig Uptown Bonifacio Tower 3

SKILL AND QUALIFICATIONS: • Bachelor of Science Nursing (BSN) degree or General Nursing & Midwifery (GNM) Diploma or Basic Bachelor of Science (BSC) in Nursing degree or Associate Nursing Degree or Nursing Diploma • Holds current and unrestricted US Registered Nurse license • 3 months clinical experience (480 hours of working experience as a RN) • Work experience as an active RN license and providing direct patient care • Clinical setting includes inpatient hospital, outpatient hospital or community clinic • No state license required (doability will be revisited if there's a specific state of RN license needed) • With at least 3-month UM experience • With Supervisory experience Flex: • Open to candidates (without UM experience) with Appeals experience

Taguig

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