RN Clinical Appeals Specialist - Medicaid & NCQA

NTT DATA in Manila is seeking a BPO Clinical Review Specialist who will be responsible for preparing case reviews for Medical Directors and ensuring timely responses to appeals. Candidates must be Registered Nurses with experience in processing appeals or utilization management.

Strong communication and analytic skills are essential, along with knowledge of NCQA and Medicaid regulations. The position requires working during US daytime hours, promoting a collaborative environment.