GBSC - Clinical Program Nurse II
Crawford & Company
Date: 13 hours ago
City: Manila
Contract type: Full time
Responsible for reviewing medical information to determine if requested treatment is medically necessary and appropriate according to the given standards
- Evaluation of Medical Information
- Analyzes medical information and applies established criterion to facilitate the utilization review process.
- Collaborates objectively with peer physicians to facilitate case resolution.
- Utilizes appropriate resources to perform utilization review process.
- Documents pertinent information in internal and external communications to support utilization management determinations and case resolutions.
- Adheres to the given standard operating procedures (SOP) and turnaround time to complete the review process.
- Demonstrates knowledge and understanding of Broadspire medical department policies and procedures and ability to communicate same with internal/ external customers as necessary.
- Analyzes medical information and applies established criterion to facilitate the utilization review process.
- Business Process Support
- Plans and organizes individual caseload to meet requirements.
- Communicates effectively with persons involved in the review process as needed.
- Refers matters beyond limits of authority and expertise to immediate superior for direction.
- Upholds the Crawford Code of Conduct by protecting the confidentiality of information.
- Performs other related tasks as required or needed.
- Demonstrates knowledge and understanding of Broadspire medical department policies and procedures and ability to communicate same with internal/ external customers as necessary.
- Plans and organizes individual caseload to meet requirements.
- Bachelor’s degree in Nursing.
- Must have an active and in good standing without restriction Philippine RN license.
- Minimum of one (1) year diverse clinical experience or prior experience in medical bill review or claim/case review.
- Must complete continuing education requirements mandated the Professional Regulation Commission.
- Must complete courses as outlined by Crawford Educational Services.
- Good communication skills.
- Proficient in word processing software applications.
- Analytical skills - Ability to perform basic bill review according to standard operating procedures (SOP).
- Maintains high degree of professionalism and confidentiality.
- Ability to multi-task, prioritize and manage time effectively.
- Interpersonal skills - Able to work independently and as a team member.
- Keen attention to details.
How to apply
To apply for this job you need to authorize on our website. If you don't have an account yet, please register.
Post a resumeSimilar jobs
Employee Compliance Associate
Macquarie Group Limited,
Manila
11 hours ago
Join our Employee Compliance team and play a key role in the review and processing of matters, data analysis and reporting. This is an exciting opportunity for you to leverage your technical experience in personal compliance and data analysis to grow your personal risk framework and policy knowledge.
At Macquarie, our advantage is bringing together diverse people and empowering them...
Account Manager I
JPMorganChase,
Manila
14 hours ago
JOB DESCRIPTION
You are a natural leader. You do what’s right for customers and colleagues and you inspire others to do the same.
Join our dynamic team and make a meaningful impact by leading your team to create great customer experiences that cultivate long-lasting relationships. As an Account Manager I in Home Lending, you will directly manage a group of...
Medical Contact Center Assistant I
Fortrea,
Manila
2 days ago
As a leading global contract research organization (CRO) with a passion for scientific rigor and decades of clinical development experience, Fortrea provides pharmaceutical, biotechnology, and medical device customers a wide range of clinical development, patient access, and technology solutions across more than 20 therapeutic areas. Conducting operations in ~100 countries, Fortrea is transforming drug and device development for partners and...
