QUALIFICATIONS:

• Bachelor's Degree in Nursing with an active and valid license in PHRN or USRN

• Minimum of 1 year InterQual criteria experience

• Minimum of 2 years bedside experience as an ER or ICU nurse (Acure Care bedside experience)

• Must have experience in utilization management with a US-based insurance company or hospital (or equivalent)

• Experience as a Team Lead or Supervisor for at least 1 year, in a similar support environment - other related roles exposed to related functions are also considered.

• Experience in a hospital setting or other clinical environment/ contact center setting

• Excellent verbal and written communication skills

• Strong attention to detail and case documentation practices

• Ability to manage multiple cases and meet regulatory turnaround time under pressure

•  Proficient in basic Microsoft Office applications such as Word, Excel, and Outlook

•  Strong clinical knowledge, particularly in medical necessity review and interpretation of clinical documentation

•  Good knowledge and understanding of different healthcare insurance processes, appeals, grievances, and utilization management is preferred

• Willingness to work on-site with flexible schedules, including US hours and holidays

• Must not be a current or former employee of Concentrix