DE033033-Health Clinical Services Senior Analyst

---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 Services Senior Analyst WORK SETUP: RTO OVERALL PURPOSE: 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: Night Shift Project Rest Day: Rotation Project/Team Location: Taguig, Uptown Bonifacio Tower 3• 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 Flex: Open to candidates (without UM experience) with Appeals experience

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