Nurse Consultant – USRN

Nurse Consultant – NCLEX (USRN)

Industry: BPO / US Healthcare

Location: Infopark, Kakkanad, Kochi

Shift: 6:00 PM to 3:00 AM, Monday to Friday

Weekly Off: Saturday and Sunday

Salary

55,000/- to 75,000/- for Clinical Exp
up to 10LPA for BPO Experienced Candidate
Eligibility Criteria

License: NCLEX-RN certification is mandatory.
Qualification: BSc Nursing / Post BSc Nursing only.
Experience: Minimum One Year, provided they are NCLEX-RN certified.
Communication: Excellent fluency in English is required.

Required Skills

Strong clinical knowledge and nursing background.
Good understanding of medical terminology and patient care documentation.
Excellent English communication skills.
Ability to work in a US healthcare process environment.
Willingness to work in evening/night shift.
Responsibilities

Review and analyze medical claims, provider appeals, and dispute cases within the US healthcare insurance process.
Evaluate clinical documentation, medical records, and supporting evidence to determine medical necessity and appropriateness of care.
Assess healthcare claims using clinical guidelines, payer policies, and utilization management criteria.
Collaborate with physicians, healthcare providers, and internal teams to gather and review additional clinical information.
Ensure compliance with US healthcare regulations, insurance policies, payer guidelines, and quality standards.