Clinical Reviewer
Genfinity
Posted
last week
Makati, National Capital Region, Philippines
Onsite
PHP 50K
Mid Level
Full Time
Sema Summary
The Clinical Reviewer will evaluate medication prior authorization requests according to New York State regulations. Candidates should have strong clinical assessment skills and a proactive approach to problem-solving.
About Company
Genfinity specializes in outsourcing and offshoring consulting, helping businesses leverage the Philippine BPM support industry. With over 13 years of experience, they assist in establishing operations and enhancing processes in various sectors.
Core Requirements
- Active Philippine Nursing license
- 2 years experience in Utilization Review
- Knowledge of HIPAA principles
- Proficiency in Microsoft Office
- Excellent organizational skills
Responsibilities
- Evaluate and approve or deny medication prior authorization requests.
- Work in designated queues for business-related tasks.
- Assist with medical decisions in the client portal.
- Act as Workload Administrator within the NYS WCB.
- Enter Medical Determinations within 4 days.
- Meet required metrics while ensuring quality standards.
- Adhere to all policies and procedures.
Must Have skills
Job Keywords
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