Global Health Care Specialist

9 hours ago


Indianapolis, Indiana, United States International Medical Group Full time
Job Summary

The Global Health Care Specialist will evaluate medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities for utilization review and/or evacuation/repatriation.

Key Responsibilities
  • Evaluate medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities for utilization review and/or evacuation/repatriation.
  • Work as a liaison between the Insured, the insurance carrier, and the Insured's healthcare team to meet the requirements of the Insured's policy in the United States and abroad.
  • Perform Certifications, Concurrent Reviews, Retrospective Reviews, and Medical Evacuations/Repatriations including inpatient and outpatient management of assistance cases.
  • Document information and status in case management systems and document.
  • Prepare precertification and/or case management reports as needed.
  • Use good judgment when evaluating medical cases and confer with Medical Director when necessary.
Requirements
  • Current and active Nursing license - Registered Nurse
  • Minimum two years acute hospital-based experience providing direct patient care
  • Good computer skills including familiarity with the Internet, Word, and Excel
Preferred Skills
  • B.S.N.
  • Minimum two years utilization review with a managed care or insurance company
  • Proficient verbal and written communication skills in a foreign language preferred
Work Environment

The Global Health Care Specialist will work in an office environment setting, with 90% of the time spent sitting, doing keyboard entry, and utilizing a mouse.



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