Nurse Utilization and Clinical Advisor Services Analyst II - Conduent

Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments – creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.

Conduent is seeking a Nurse Utilization/Clinical Advisor Services Analyst in the Ridgeland, Mississippi area. While the person in the role will be able to work remotely, he/she will need to reside in or near Ridgeland.

Responsibility Statements

• Applies medical judgment to adjudication of cases/claims.
• Reviews requests for denial reconsideration and appeals.
• Manually price and review claims for appropriateness of care or coverage.
• Works directly with the client to provide input under program policy or procedural requirements.
• Coordinate with clinical peer reviewers for case/claim resolution.
• Performs other duties as assigned.
• Complies with all policies and standards.

Requirements:

• Active Registered Nursing License with MS or Multistate license
• Minimum of two to four years of clinical experience, Ability to review medical record and identify all aspects of clinical chart.
• Ability to comprehend medical policy and criteria to clearly articulate health information
• Analytical, problem-solving and decision-making skills
• Not sanctioned or excluded from the Government Programs by the OIG
• Excellent written, oral and interpersonal communication skills
• Knowledge of Medicaid Management Information System (MMIS)
• Proficiency in MS Office, MS Word, MS Excel, MS Outlook

Preferred Skills:

• Prior functional working experience in claims medical records review arena
• Prior functional working knowledge of appropriate billing and coding guidelines
• Familiarity and understanding of the Medicare, Medicaid and/or Managed Care regulatory guidelines and associated requirements

Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.

People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the "Submit" button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form. You may also click here to access Conduent’s ADAAA Accommodation Policy.

At Conduent we value the health and safety of our associates, their families and our community.  For US applicants while we DO NOT require vaccination for most of our jobs, we DO require that you provide us with your vaccination status, where legally permissible. Providing this information is a requirement of your employment at Conduent.