Manager
Company: EXL
Role summary
Manager is a full-time role at EXL in Pune, Maharashtra, India (on-site). Posted 2026-10-21. Experience level: 10+.
- Job title
- Manager
- Company
- EXL
- Location
- Pune, Maharashtra, India
- Work arrangement
- on-site
- Employment type
- full-time
- Category
- Healthcare Support
- Experience level
- 10+
- Date posted
- 2026-10-21
You’ll be playing a vital role in patient care by helping evaluate clinical decisions and medical necessity for complex cases alongside a team of directors. It’s an ideal spot for an experienced clinician looking to transition into a leadership-focused role that emphasizes evidence-based practices and clear communication with healthcare providers.
Job description
Works with Regional Medical Directors to make sound, evidence based clinical decisions regarding the requested cases (treatments and procedures) for IP/OP and performs retrospective clinical reviews utilizing criteria set forth by the client and Medicare (CMS-Centers for Medicare and Medicaid Services) and perform outbound calls to providers.
Responsibilities
Performs clinical review of cases received from the specialist team or other departments within CCR, determines if additional clinical information if required, makes a clinical decision to approve or deny a case based on plan coverage, criteria and / or guidelines or pend / refer it to the Regional Medical Directors for further review for medical necessity, and coordinates a peer to peer (doctor to doctor case discussion) review as applicable.
Qualifications
Bachelor Degree in relevant field with 6- 8 years of relevant experience