fbpx PHRN - NURSE UTILIZATION AND CLINICAL ADVISOR SERVICES ANALYST II | Pasay, Pasay City | conduent

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PHRN - NURSE UTILIZATION AND CLINICAL ADVISOR SERVICES ANALYST II

Qualification:
Job Track Description:
  • Requires formal education and relevant expertise in a professional, sales, or technical area.
  • Performs technical-based activities.
  • Contributes to and manages projects.
  • Uses deductive reasoning to solve problems and make recommendations.
  • Interfaces with and influences key stakeholders.
  • Leverages previous knowledge and expertise to achieve results.
  • Ability to complete work self-guided.
  • College or university degree required.
General Profile
  • Requires knowledge and experience in the field.
  • Will acquire higher-level knowledge and skills.
  • Develops an understanding of the company, processes, and customers.
  • Uses existing procedures to solve routine or standard problems.
  • Receives moderate guidance and direction from others.
Functional Knowledge
  • Requires expanded conceptual understanding of theories, practices, and procedures. 
Business Expertise
  • Uses an understanding of key business drivers to accomplish work.
Impact
  • Impacts a team, by example, through the quality service and information provided
  • Works within guidelines and policies.
Leadership
  • No supervisory responsibilities.
  • Provides informal guidance to new team members.
Problem Solving
  • Uses existing procedures to solve standard problems.
  • Examines information and standard practices to make judgments.
Interpersonal Skills
  • Exchanges complex information and ideas effectively.
Responsibility Statements
  • Applies medical judgment to adjudication of cases/claims.
  • Reviews requests for denial reconsideration and appeals.
  • Manually price and review claims for appropriateness of care or coverage.
  • Works directly with the client to provide input under program policy or procedural requirements.
  • Coordinate with clinical peer reviewers for case/claim resolution.
  • Performs other duties as assigned.
  • Complies with all policies and standards.
Additional Information
  • Requires Registered Nurse license in good standing.