Clinical Utilization Review Specialist (US Healthcare)

Job Title: Clinical Utilization Review Specialist (US Healthcare – India Based)

Company: CORE OBJECTIVE SOLUTIONS, LLC / CORE CLINICAL SERVICES
Location: Pune, India

Shift: Flexible
Industry: US Healthcare – Utilization Management
Salary: Excellent Package with Incentives

At CORE OBJECTIVE SOLUTIONS, LLC / CORE CLINICAL SERVICES, we are expanding our clinical operations team in India to support leading healthcare organizations in the US. We are seeking qualified and experienced Doctors (BAMS, BHMS) and Nursing Graduates (B.Sc Nursing) who have at least 1 year of experience in Utilization Review (UR).

Description

This role involves reviewing patient cases for medical necessity, treatment appropriateness, and quality of care using InterQual and/or MCG guidelines. This is a non-patient-facing clinical role, ideal for professionals who want to leverage their medical knowledge in a global setting.

Key Responsibilities

• Perform pre-authorization, concurrent, and retrospective reviews for medical services
• Use InterQual or MCG guidelines to assess treatment appropriateness
• Escalate complex cases to physician reviewers as per protocol
• Accurately document case reviews in the Utilization Management (UM) system
• Adhere to client-specific policies, timelines, and HIPAA compliance
• Participate in training, quality audits, and team collaboration

Candidate Profile

Education

• BAMS /BHMS / B.Sc Nursing from a recognized university

Experience

• Minimum 1 year of experience in Utilization Review / Utilization Management
• Mandatory: Hands-on experience with InterQual and/or MCG tools

Skills

• Strong clinical understanding and judgment
• Familiarity with US healthcare processes and terminology
• Good written and spoken English communication skills
• Comfortable with documentation and healthcare software tools
• Ability to work independently and manage priorities in a fast-paced environment

Why Join CORE CLINICAL SERVICES?

• Work with leading US healthcare clients from India
• Attractive salary with performance-linked incentives
• Continuous learning and upskilling in global healthcare standards
• Supportive work environment with opportunities for growth in clinical operations, training, or leadership

Apply Now

If you’re passionate about making a difference in global healthcare and have the experience we're looking for, we want to hear from you!

Send your resume to: hr@coreclinicals.com

Visit us: www.coreobjectivesolutions.com

Job Types: Full-time, Permanent

Application Question(s):

• How many years of experience you have in UM?

Work Location: In person