Health Clinical Services Senior Analyst

Halfspace ApS

Not specified
Utilization management pre-service review
Milliman or interqual criteria application
Medical policy compliance verification
Halfspace ApS is seeking a Health Clinical Services Senior Analyst to conduct utilization management activities, ensuring compliance with medical policies and member eligibility. The ideal candidate will possess a Bachelor of Science in Nursing and have at least three months of experience as a Registered Nurse, showcasing strong communication and clinical skills

Job Summary

  • The role involves conducting comprehensive utilization management reviews including pre-service, concurrent, and retrospective assessments to ensure medical necessity.
  • Candidates must utilize specific client criteria sets like Milliman or InterQual to approve cases or route them to nursing reviewers and medical staff.
  • The position requires collaboration with providers and medical directors to facilitate high-quality, cost-effective care throughout the healthcare continuum.

Matching Summary

Match Score: 85

Halfspace ApS is seeking a Health Clinical Services Senior Analyst to conduct utilization management activities, ensuring compliance with medical policies and member eligibility. The ideal candidate will possess a Bachelor of Science in Nursing and have at least three months of experience as a Registered Nurse, showcasing strong communication and clinical skills.

Skills & Requirements

Must-have

  • Utilization Management pre-service review
  • Milliman or InterQual criteria application
  • Medical policy compliance verification
  • Provider collaboration for discharge planning
  • Client-specific clinical guidelines usage

Nice-to-have

  • Excellent written and verbal communication skills
  • Proactive planning for member care transitions
  • Experience with cost-effective healthcare settings

Key Requirements

  • Current unrestricted US Registered Nurse license
  • Bachelor of Science Nursing (BSN) degree
  • Minimum 3 months RN clinical experience (480 hours)
  • State-specific RN licensure as required
  • Direct patient care in hospital or clinic setting

Work Rights

Must have US work authorization

Tailored Resume

Cover Letter