Philippine Registered Nurse PHRN - NCLEX Scholarship

Philippine Registered Nurse PHRN – NCLEX Scholarship

Requirements:

  • Must have an Active PRC Nursing License.
  • At least 1 year of cumulative clinical bedside care experience (hospital, clinic, healthcare facility, etc.) or business process experience (healthcare data management), or any combination which would provide an equivalent background.
  • Experience with daily operations in a clinical, managed care, hospital care setting including working with provider systems and medical providers is an advantage.
  • Prior Utilization Management or Prior Authorization Clinical Experience is an advantage, but not required.
  • Role requires strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
  • Amenable to do review/work on a remote setup (WFH) and willing to work at Pasay City site in casework on-site resumes.
  • Must have a minimum of 25mbps wired internet speed.

Responsibilities:

  • Review service requests to ensure compliance with applicable criteria, medical policy, member eligibility, benefits, and contracts.
  • Route cases to client medical staff for further review when a service or admission does not meet medical necessity, place of service, or benefits criteria.
  • Work with clinical reviewers and medical directors in interpreting appropriateness of care and conducting claims reviews utilizing the member’s benefit contract and health plan guidelines.
  • Process incoming requests, collection of information needed for review from providers.
  • Determine contract and benefit eligibility, obtain intake demographic information from callers and/or faxes.

 

More Information

Apply for this job
Share this job

Global Headstart Specialist, Inc.

Get on the right track. Get on the fast track. Get a HEADSTART.
Company Information

The number 1 Job Portal in the Philippines. Find your first job today!

CONTACT US

info@jobozuki.com

31F, Yuchengco Tower 1, RCBC Plaza, 6819 Ayala Ave, Makati City