Key Responsibilities :

•Review and verify medical reports for accuracy
•Maintain and update documentation systems
•Handled communications with stakeholders
•Monitor compliance with healthcare regulations

Non-Negotiable Requirements:
•Active and unrestricted U.S. Registered Nurse (USRN) license.
• Minimum 2 years of clinical bedside experience (ER, ICU, Med-Surg, Telemetry preferred).
• Minimum 1 year of USRN BPO or U.S. Healthcare experience in UM, CM, Appeals, Triage, or related clinical processes.
• Knowledge of MCG/Milliman, InterQual, clinical guidelines, HIPAA requirements, and U.S. medical terminology.
• Prior experience as a Quality Analyst, Clinical Auditor, or Clinical Reviewer in a U.S. healthcare account.
• Strong analytical skills with high attention to detail and documentation accuracy.
• Excellent written and verbal communication skills.

Preferred
• Familiarity with coding systems (ICD-10, CPT) is a plus.
• Strong proficiency in MS Office tools and QA evaluation systems.