Philippines Job Openings

Shearwater Health Advisors Inc

USRN with Utilization Management experience

Quezon City

FULL TIME

October 31, 2024

Let your Passion Lead You at the Home of Clinicians with over 5000+ employees who have trusted us with their careers!
Physical Sites: Taguig, Cebu, and Pampanga
Our Clinicians & Associates advocates for better patient care while enjoying these benefits:
  • HMO on Day 1 with 2 Dependents upon regularization.
  • Group Life Insurance
  • Highly Competitive Salary
  • Complexity Allowance
  • Annual Salary Increase
  • Quarterly Performance Bonus
  • Service Incentive Leave (SIL) with Leave Conversion
  • Work-Life Integration
  • Get Visa Sponsorship & Work Abroad (*)
  • *Terms and Conditions Apply
The USRN Utilization Management Nurse role is responsible in performing medical necessity review of proposed prospective, concurrent, and retrospective cases such as medical treatments, auto-injury related request, hospitalization, home care, and inpatient/outpatient treatment plans for medical necessity and efficiently in accordance with the client's-specific contract rules and guidelines and with company's policies, practices and procedures to facilitate quality and cost effective care for the injured employee. Summarize clinical documents, provide guidelines, draft medical necessity determinations, requests additional clinical information if required.
What we look for:
  • Must have an active US Nursing License
  • Must be a valid Philippines passport holder
  • With at least one (1) year of recent hospital bedside care experience
  • Experience in Utilization Management, Coding, Back office, and other CPO related processes
  • Knowledgeable in Medical/Clinical Summary Writing
  • With excellent Communication, Organizational, Time Management, and Interpersonal skills
  • Must be amenable for a graveyard shift or any shift schedule
  • Must be amenable to report onsite (Taguig/Pampanga/Cebu)
Note: Only USRN profiles with Utilization Management/Review experience will be shortlisted.
#SWHH
Job Types: Full-time, Permanent
Benefits:
  • Flexible schedule
  • Health insurance
  • Life insurance
Schedule:
  • Monday to Friday
Supplemental Pay:
  • 13th month salary
  • Performance bonus
  • Quarterly bonus
Education:
  • Bachelor's (Required)
License/Certification:
  • PRC License (Required)
  • USRN License (Preferred)
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