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.