Wehire Talent Solutions
Job description :-
Key Responsibilities:
1. Collaborate with hiring managers to identify staffing needs and develop recruitment strategies.
2. Source potential candidates through online channels, job fairs, and networking events.
3. Screen resumes and conduct interviews to assess candidate qualifications.
4. Coordinate with hiring managers to schedule interviews and facilitate the selection proces
CliniLaunch Business Solutions Pvt. Ltd.
CliniLaunch Business Solutions Pvt. Ltd. is hiring US Registered Nurses.As a US Registered Nurse - Reviewer, you will play a critical role in performing medical necessity reviews, claims evaluations, and ensuring regulatory compliance.
Job Description:-
• Conduct clinical reviews of authorization requests to determine medical appropriateness.
• Assess and interpret member contracts to ensure claims compliance.
• Analyze healthcare services using knowledge of ICD and CPT codes.
• Apply Milliman guidelines for decision-making (preferred).
• Communicate effectively with physicians, members, and providers.
• Document findings and compose clear reports as per standard operating procedures.
• Support utilization management processes and facilitate efficient healthcare delivery.
Qualification Required:-
BSc/MSc Nursing with NCLEX certification and an active US RN license.
iJobz Consultancy
CONTINUITY 1 TECHNOLOGIES PRIVATE LIMITED