Case Analyst (non voice & voice) | USRN  

HGS is currently looking for USRNs to work as a Case Manager. As a case manager, you can choose from either of the two: you’ll be more of like a nurse handling cases & patients in the US or you’ll be doing case reviews/offline analysis.

• Documents all activities in the appropriate system(s) on a timely basis
• Reviews individual medical cases to confirm that they are getting the most appropriate care
• Weighs the patient's situation against the policy held by the patient, the standards of the insurance company, and the costs which may be involved in treatment
• Promote the quality and cost effectiveness of medical care by applying clinical knowledge and the appropriate application of policies and guidelines to prior authorization requests
• Ensures that prior authorization requests are completed in a timely fashion to meet contractual requirements and that all reviews are conducted using nationally recognized and evidence based standards
• Evaluates the pre-service authorization request received for scheduled inpatient admissions, ambulatory surgeries, and outpatient services and out of network providers
• Determines the appropriate level of care for patient stays in acute care facilities in compliance with acute care guidelines; prior authorization medical necessity review, including determination of appropriate provision of observation care, outpatient or inpatient rehabilitation services, DME, Home Health and other ancillary healthcare services in compliance with approved care guidelines
• Accurate, thorough and efficient review of authorization requests

• Active USRN License (Mainland State only) for the next 3 months
• Must have at least 2 years of Clinical Experience in a Hospital or Clinic Setting
• Has good customer service orientation
• Has good communication and interpersonal skills
• Has good analytical and problem solving skills
• Knowledgeable in MS Office and internet browsing
• Amenable to work in a graveyard shift
• Amenable to work in Eastwood City