Philippines Job Openings
Crawford & Company
GBSC - Clinical Program Nurse II
Manila
FULL TIME
September 3, 2024
-
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.
New Job Alerts
Northpoint Development Bank
Bank Compliance Staff
General Mariano Alvarez
FULL TIME
November 6, 2024
View Job Description
AboitizPower
Corporate Planning and Business Performance Specialist
Taguig
FULL TIME
November 6, 2024
View Job Description
DICE205 Digital Corporation
Creatives Intern
Makati City
PART TIME
November 6, 2024
View Job Description
Looking for similar job?
Crawford & Company
GBSC - Administrative Assistant
Iloilo
FULL TIME
October 19, 2024
View Job Description
Access Healthcare
Clinical Auditor | Nurse Auditor | PHRN ( Healthcare BPO )
Taguig
FULL TIME
September 1, 2024
View Job Description
Access Healthcare Services Pvt Ltd
Team Leader, Clinical Account (Must be PHRN)
Taguig
FULL TIME
September 4, 2024
View Job Description
Access Healthcare Services Pvt Ltd
Registered Nurse - Clinical Appeals and Review
Taguig
FULL TIME
September 3, 2024
View Job Description
Conduent Business Services Philippines, Inc.
Nurse Utilization and Clinical Advisor Services Analyst II
Pasay
FULL TIME
September 3, 2024
View Job Description
See What’s New: Crawford & Company Job Opportunities
Crawford & Company
GBSC - Administrative Assistant
Iloilo
FULL TIME
October 19, 2024
View Job DescriptionNew Job Alerts
Northpoint Development Bank
Bank Compliance Staff
General Mariano Alvarez
FULL TIME
November 6, 2024
View Job Description
AboitizPower
Corporate Planning and Business Performance Specialist
Taguig
FULL TIME
November 6, 2024
View Job Description
DICE205 Digital Corporation
Creatives Intern
Makati City
PART TIME
November 6, 2024
View Job Description