Medicine Job at Infosys | Clinical Role in Pune – Apply
Looking for a Medicine Job with a leading global organization? Infosys Limited is hiring a Clinical Lead in Pune under its Platforms & Services Unit. This opportunity is ideal for experienced healthcare professionals seeking Infosys Careers in utilization management, clinical operations, and regulatory compliance within a dynamic clinical job environment.
Job Details:
- Job Title: Clinical Lead
- Location: Pune
- Job ID/Reference Code: INFSYS-EXTERNAL-238904
- Work Experience: 5 – 9 Years
About the Company
Infosys Limited is a global leader in digital services and consulting, delivering innovative healthcare and life sciences solutions. As part of Infosys Careers, professionals gain exposure to large-scale healthcare transformation programs, advanced clinical platforms, and regulatory-driven environments. Infosys Jobs in the healthcare domain provide strong career progression and leadership opportunities.
Qualifications:
- Bachelor’s or Master’s degree in medicine, Healthcare Administration, Public Health, or related field.
- Certification in Case Management or Utilization Management (CCM, ACM-RN, CPUR, CPHM).
- Experience with Medicare Advantage, Medicaid Managed Care, or Commercial health plans.
- Familiarity with UM and CM platforms such as GuidingCare, MHK, HealthEdge, TruCare, and CaseTrakker.
- Experience in provider relations, audit support, or process improvement initiatives.
Technical and Professional Requirements:
- Active, unrestricted RN license (or clinical licensure appropriate for UM).
- 10+ years of clinical experience in utilization management, care management, or clinical review roles.
- Strong understanding of InterQual/MCG criteria, medical necessity reviews, and authorization processes.
- Knowledge of federal and state UM regulations, CMS guidelines, NCQA/URAC standards, and HIPAA.
- Excellent clinical judgment, communication, and documentation skills.
Preferred Skills:
- Domain -> LifeSciences -> Clinical Trials
- Compliance & Safety
- Technology -> Oracle Industry Solutions -> Oracle Clinical -> Oracle CDA [Clinical Data Analytics]
Key Responsibilities:
- Conduct and oversee utilization reviews (prospective, concurrent, and retrospective) using evidence-based criteria such as InterQual, MCG, CMS, and state guidelines.
- Perform clinical reviews of inpatient, outpatient, specialty, and ancillary services to determine medical necessity, level of care, and appropriateness.
- Oversee the intake, triage, and review of service authorization requests (e.g., DME, home health, specialty services, behavioral health, advanced imaging).
- Ensure timely processing of authorizations within regulatory and contractual turnaround times (TATs).
- Support transitions of care, coordination between UM and CM, and continuity across inpatient and outpatient settings.
- Provide guidance to Care Managers on clinical issues impacting utilization, level of care, or benefit coverage.
- Ensure compliance with CMS, state Medicaid, DOI, and accreditation standards related to UM/CM (NCQA, URAC).
- Serve as a subject matter expert for clinical reviews, UM criteria, and service authorization workflows.
- Provide coaching, training, onboarding, and daily support to nurses, UM coordinators, and CM staff.
- Collaborate with providers on clinical documentation requirements, UM criteria, and decision rationales.
- Monitor UM metrics, including concurrent review timeliness, appeals rates, authorization turnaround times, and readmission trends.
