Indeed
Senior Nursing Regulator - Vista Guanabara, RJ (73338)
Transforming lives through health is what drives us!
We operate across Brazil through two business units—Amil and Rede Total Care—with over 1,500 accredited hospitals and our own network of hospitals, clinics, treatment centers, home care services, and medical transportation.
With a clear mission and strong values, we strengthen our culture through a commitment to continuously improve service. We care for our employees so that this care extends to the population we serve.
**Key Responsibilities:**
* Ensure critical analysis of requests for procedure codes and OPME (implantable, prosthetic, orthopedic, and special materials) in accordance with ANS regulatory protocols and guidelines, including the ANS Procedure List (Rol) and usage directives;
* Ensure technical and critical analysis of requests in accordance with regulation/ANS protocols and guidelines, aiming to reduce the sector’s NIPs (Non-Approved Procedures) by 15%;
* Identify cases eligible for referral to the discrepancy resolution process through technical/critical analysis, contributing to a 20% increase in cases requiring adjustment;
* Identify and reduce abusive costs associated with material requests;
* Conduct recorded calls with surgeons to adjust materials;
* Route requests correctly to respective analysis teams;
* Authorize materials relevant to procedures;
* CPA (Clinical Procedure Authorization)—analyze and authorize requests within five (5) business days;
* Elective and post-surgical requests—analyze and authorize within ten (10) business days.
**Required Qualifications:**
* Completed undergraduate degree in Nursing;
* Postgraduate qualification in Health Systems Auditing and/or OPME is desirable;
* Proficiency in Microsoft Office Suite;
* Experience in Medical Billing, Operating Room/CME (Central Material Supply), and/or OPME;
* Familiarity with the Inpart system is desirable;
* Availability to work full-time on-site during standard business hours in the Centro (Downtown) region of Rio de Janeiro.
**Keywords:** Amil, Regulation, Regulator, Nursing Regulation, Nursing, Nurse, Equity, Inclusion, Diversity, PwD (Person with Disability), Rio de Janeiro, Centro, RJ.
We foster an innovative, diverse, equitable, and inclusive culture. All qualified applicants are welcome, regardless of ethnicity, race, disability, sexual orientation, gender identity or expression, age, nationality, religion, or any other social marker.
We emphasize that we do not request payments, fees, or SMS codes during our selection processes. All opportunities are published exclusively through our official channels and career website. Any deviation from this practice must be reported.

State of Rio de Janeiro, Brazil
Negotiable Salary