- Bachelor's degree in nursing (BSN)
- Active unrestricted RN license that can be validated thru PRC website
- 1-2 years of relevant Clinical experience in any medical/surgical department, Orthopedic, Medical/Surgical ICU, Coronary Care Unit (CCU), Rehabilitation, Emergency department
- Written and verbal fluency in English
- Candidate should be willing to work onsite (BGC)
- Proficiency in all Microsoft Office products including Project, Word, Excel, PowerPoint, Visio, and SharePoint
- Knowledge of workers' compensation laws and regulations, behavioral health, case management practice, URAC standards, ODG, Utilization review, pharmaceuticals to treat pain, pain management process, drug rehabilitation, state workers compensation guidelines, periods of disability, and treatment needed
- Leadership/management/motivational skills as well as analytic and strong organizational skills
- Ability to work in a team environment and to meet or exceed Performance Competencies
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Utilization Reviewer
1 linggo ang nakalipas
Gratitude Philippines Taguig, Pilipinas Buong orasRoles and Responsibilities: · • PH Nurses to review treatment authorization request based on state guidelines and medical necessity and take decision to approve/deny. In case of denial send this to independent panel review to support the decision. Nurses will work with Claims adj ...
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Utilization Reviewer
4 araw ang nakalipas
Gratitude Philippines Taguig, Philippines, Pilipinas Buong orasRequired Qualifications · Bachelor's degree in nursing (BSN) · Active unrestricted RN license that can be validated thru PRC website · 1-2 years of relevant Clinical experience in any medical/surgical department, Orthopedic, Medical/Surgical ICU, Coronary Care Unit (CCU), Rehabil ...
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BPO Utilization Reviewer
2 araw ang nakalipas
Manpower Core Group Inc. Taguig, Pilipinas Buong orasSummary:The Clinical Review Nurse position assesses the medical appropriateness of proposed treatments and medications for our injured employees, and partners with the Client Claims Adjuster team to expedite medically necessary treatment for each claim. Maintains a solid understa ...
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Utilization Review Nurse
4 araw ang nakalipas
AGS Health LLC Metro Manila / NCR, Pilipinas Buong orasDear Candidate, · Greetings from AGS Health. · We are happy to share our job opening. · Job title- Utilization review nurse · Mode of work - Onsite · Location – Cyber sigma, Lawton Ave, Mckinley West, Taguig, 1634 Metro Manila, Philippines · Responsibilities:Contact insurance car ...
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Training Admin Specialist
4 araw ang nakalipas
Teleperformance Taguig, Pilipinas Buong orasJob Summary: · Receive and process training requests (i.e. organize and publish training schedules and rosters daily/ weekly/ monthly on company tools such as CCMs, TPnet, etc). · Review sign-up requests in TP-link and enroll in participants via Coursemill. · Manage logistics of ...
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Clinical Denials Clinician
4 araw ang nakalipas
Conifer Health Solutions Philippines, Taguig, Pilipinas Buong orasThe Clinical Denials Clinician of AR Management is responsible for recovering revenue through a.) intelligent and ethical investigation of disputed/denied clinical claims, b.) verifying eligibility for clinical review, and c.) preparation and documentation of appeals based on ind ...
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Medical Reviewer
1 linggo ang nakalipas
eData Services US, L.L.C. Taguig, Philippines, Pilipinas Buong orasJob Description: · Responsible for reviewing and analyzing documents pertaining to an individual, and composing accurate and complete reviews of records, either by paraphrasing or quoting the original documents, utilizing the Client guidelines. · Â · Coordinates with the Product ...
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Medical Reviewer
4 araw ang nakalipas
eData Services US, L.L.C. Taguig, Philippines, Pilipinas Buong orasJob Description: · Responsible for reviewing and analyzing documents pertaining to an individual, and composing accurate and complete reviews of records, either by paraphrasing or quoting the original documents, utilizing the Client guidelines. · Â · Coordinates with the Product ...
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usrn
4 araw ang nakalipas
Gratitude Philippines Taguig, Philippines, Pilipinas Buong orasUS RN certification – Mandatory. · With five years of experience in utilization management review or 3 years clinical appeals and denials handling for healthcare insurance/ UMR · Salary range – 30-50K · Experience range - 5+ years · Shifts – flexible · Onsite in Taguig ...
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Clinical Support Specialist
4 araw ang nakalipas
Eviden Philippines, Taguig, Pilipinas Buong orasShift Schedule: Nightshift · Work Setup: Hybrid · Summary: · The clinical support specialist (CSS) provides administrative support to clinical staff within Member Health. The CSS adheres to established customer service standards of accuracy, courtesy, and professionalism. This po ...
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Quality Assurance Specialist
1 linggo ang nakalipas
Gratitude Philippines Taguig, Pilipinas Buong orasResponsibilities:Carry out quality assurance oversight activities defined in the Client Managed Care National Best Practices and Quality Assurance StandardsConduct regular and systematic review of Managed Care internal and external claim files with focus towards validation of con ...
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Full Stack Engineer
4 araw ang nakalipas
White Cloak Technologies, Inc. Taguig, Philippines, Pilipinas Buong orasResponsibilities: · Responsible for the delivery of assigned modules / tasks. · Code, test and troubleshoot software programs utilizing the appropriate hardware, database, and programming technology. · Provide assistance to QA as needed to diagnose system problems and to review/r ...
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AML/KYC Compliance Coordinator
4 araw ang nakalipas
Baker McKenzie Philippines, Taguig, Pilipinas Buong orasThe AML/KYC Compliance Coordinator will undertake detailed analytical research of clients and parties on a global basis to provide efficient and effective Client Due Diligence (CDD) services to Firm Partners and local offices in new and existing client registrations and matters. ...
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automation engineer
4 araw ang nakalipas
Metrobank Taguig, Philippines, Pilipinas Buong orasThe RPA Solutions Architect will be the primary resource in designing process automation solutions that will be cost efficient, sustainable, adaptable, reusable and scalable for the organization. This also includes continuous review and rebuilding designs for existing process aut ...
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GBSC - Clinical Program Nurse I
4 araw ang nakalipas
Crawford & Company (GBSC) Taguig, Philippines, Pilipinas Buong orasPosition Summary · Responsible for auditing in-patient and/or surgical bills to promote excellence in medical bill review and process improvement. · Responsibilities · A. Medical Bill Review · Processes inpatient and/or surgical bills by adhering to the given standard operating p ...
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Trust Business Development Officer
4 araw ang nakalipas
East West Banking Corporation Taguig, Philippines, Pilipinas Buong orasAbout The Job · Location: BGC · Corporate Title: Business Development Officer · Work Arrangement: Onsite · Our Financial Markets & Wealth Management team is looking for experienced professionals to join us in BGC, Taguig with the role of Business Development Officer. · The role ...
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usrn
1 araw ang nakalipas
Gratitude Philippines Taguig, Pilipinas Buong orasUS RN certification – Mandatory.With five years of experience in utilization management review or 3 years clinical appeals and denials handling for healthcare insurance/ UMRSalary range – 30-50KExperience range - 5+ yearsShifts – flexibleOnsite in Taguig ...
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Construction Project Manager
4 araw ang nakalipas
Collabera Digital Taguig, Philippines, Pilipinas Buong orasKEY ACCOUNTABILITIES: · Capital Expenditure Program 60% · Request, review, and approve fee proposals for Architects, engineers, surveys, building and/or site evaluations, materials, and equipment. · Facilitate, manage, and report on Project timelines and budgets as pertain to the ...
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Treasury Client Support
4 araw ang nakalipas
Axos Business Center Corp Taguig, Pilipinas Buong orasThe Treasury Management Client Services Associate will provide direct assistance, support, client onboarding and customer service to clients utilizing Treasury Management products and services. · Key Responsibilities:Lead customer training and perform installation of services pos ...
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Operations Manager
4 araw ang nakalipas
Gratitude Philippines Taguig, Philippines, Pilipinas Buong orasEducational Background: B.S Nursing · Qualifications · 8+ years of related experience or equivalent combination of education and experience · required to include 2+ years of direct clinical care OR 2+ years of case · management/utilization management required. · Bachelor's de ...
Utilization Reviewer - Taguig, Pilipinas - Gratitude Philippines
Paglalarawan
Required Qualifications: