Clinical Lead Job at Infosys in Pune
Searching for a healthcare leadership role that combines clinical expertise with utilization management and care coordination? Infosys is hiring a Clinical Lead in Pune for experienced professionals in healthcare management, utilization review, and clinical operations. This Clinical Lead Job opportunity at Infosys Careers is ideal for candidates with strong experience in care management, medical necessity reviews, and healthcare compliance. The role involves working with interdisciplinary healthcare teams, managing authorization processes, and supporting patient-centered care strategies. If you are looking for a high-growth healthcare management career in the healthcare technology sector, this Job in Pune can be an excellent opportunity.
About the Company:
Infosys is a globally recognized technology and consulting company known for delivering digital transformation, healthcare technology solutions, and business consulting services across industries. The company’s Platforms & Services Unit supports healthcare organizations through advanced healthcare management solutions, clinical operations, and technology-driven patient care systems. Infosys provides employees with opportunities to work on innovative healthcare projects while fostering professional development, collaboration, and continuous learning.
Job Details:
- Job Role: Clinical Lead
- Location: Pune
- Job ID: INFSYS-EXTERNAL-243779
- Experience Required: 5–8 Years
- Department: Platforms & Services Unit
- Employment Type: Full-Time
- Industry: Healthcare Management / Healthcare Technology
Key Responsibilities:
- Conduct utilization reviews, including prospective, concurrent, and retrospective reviews using evidence-based criteria.
- Perform clinical reviews for inpatient, outpatient, specialty, and ancillary healthcare services.
- Support collaboration with Medical Directors for complex clinical review cases and adverse determinations in this Clinical Lead Job
- Ensure utilization management processes comply with CMS guidelines, NCQA/URAC standards, HIPAA, and state regulations.
- Provide guidance and coaching on documentation quality and clinical justification.
- Oversee intake, triage, and review of service authorization requests in this Job in Pune
- Ensure timely processing of authorizations within regulatory turnaround timelines.
- Review complex authorization cases and escalate when physician review is required.
- Monitor authorization trends and provider-related issues to identify opportunities for operational improvement.
- Support care transitions and coordination between utilization management and care management teams at Infosys Careers
- Participate in interdisciplinary rounds for high-risk and complex patient cases.
- Collaborate with care management teams to identify members needing disease management or population health programs.
Educational Requirements for this Job:
- Bachelor’s or Master’s degree in Medicine, Nursing, Healthcare Administration, Public Health, or related healthcare fields.
- Active unrestricted RN license or relevant clinical licensure preferred.
- Certification in Case Management or Utilization Management such as CCM, ACM-RN, CPUR, or CPHM, is advantageous.
- Experience with Medicare Advantage, Medicaid Managed Care, or Commercial Health Plans is preferred.
Skills Required:
- Strong expertise in utilization management and clinical review
- Knowledge of InterQual, MCG, CMS, NCQA/URAC standards
- Medical necessity review and authorization management skills
- Understanding of HIPAA and healthcare compliance regulations
- Strong clinical judgment and decision-making abilities
- Excellent communication and documentation skills
- Experience with UM and CM platforms like GuidingCare, HealthEdge, TruCare, or MHK
- Ability to manage interdisciplinary healthcare coordination
- Leadership and staff coaching capabilities
- Analytical and problem-solving skills in healthcare operations
Benefits of the Clinical Lead Job:
- Opportunity to work with a leading global technology and healthcare solutions company
- Exposure to advanced healthcare management systems and clinical operations
- Career growth in utilization management and healthcare leadership
- Opportunity to work on complex healthcare and care management projects
- Collaborative and technology-driven work environment
- Professional development and certification support opportunities
- Exposure to healthcare analytics and process improvement initiatives
- Strong learning opportunities in healthcare regulations and compliance
- Competitive compensation and employee benefits
- Opportunity to contribute to patient-centered healthcare delivery and operational excellence
