Job Description

NTT DATA Services in Manila seeks a Utilization Review Medical Appeals Nurse (USRN) to join our team. The role focuses on clinical reviews to determine medical necessity, preparing case reviews for Medical Directors, and ensuring timely processing per NCQA and regulatory standards.

Excellent communication is essential, with ability to work remotely. The USRN will coordinate with providers and departments, improve appeals processes, and maintain files for appeals while aligning with Medicaid

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