RESPONSIBILITIES:
- Perform Utilization Review activities prospectively, concurrently, or retrospectively in accordance with the appropriate jurisdictional and/or evidence-based guidelines.
- Responsible for helping to ensure requests for treatment are directly related to the compensable injury using industry standards and/or state specific medical treatment guidelines and formularies.
- Objectively and critically assesses all information related to the current treatment request to make the appropriate medical necessity determination.
- Responsible for accurate documentation of Utilization Review activities in the case management and claims management systems.
- Responsible for completing timely level one reviews according to state’s requirements and communicating the UR determination to all appropriate parties.
- Communicates effectively with providers, claims adjuster, other parties as needed to expedite appropriate determinations.
- Performs other functionally related duties as assigned.
Qualification:
- Active Philippine RN license
- BPO, healthcare operations, or prior auth experience preferred
- Strong data entry, system navigation, and attention to detail
- Comfortable with repetitive workflows and client-specific systems
Job Type: Full-time
Pay: Up to Php60,000.00 per month
Benefits:
- Health insurance
Schedule:
- 8 hour shift
Supplemental Pay:
- 13th month salary
- Performance bonus
Ability to commute/relocate:
- Fort Bonifacio 1201 P00: Reliably commute or planning to relocate before starting work (Preferred)
Application Question(s):
- Current and Expected Salary
- Notice Period:
Experience:
- Hospital: 1 year (Preferred)
License/Certification:
- Nursing license (Preferred)
Work Location: In person
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