Utilization Reviewer

Roles 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 adjuster on denial decision based on risk tolerance to ensure the denial doesn't...

Summary: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 understanding of Client's mission, vision, and values. Upholds the standards of the...

Supervisory Team Lead, ERP Pro 10 Utilities The Software Support Team Lead is responsible for the day-to-day operations of their support team to ensure service goals are met and clients receive exceptional support. The position positively resolves client concerns by maintaining and growing customer relationships, coaching and guiding junior Support staff,...

Responsibilities: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 consistent evaluation of evidence-based medicine, comprehensive assessments,...

Data Entry Clerk / Reviewer (Start ASAP) Taguig Opportunity Expired Be a Reviewer in the Healthcare industry The Records Reviewer is 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...

US 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

Data Entry Healthcare Account Medical Non Voice Posted 3 days ago and deadline of application is on 12 AugRecruiter was hiring 2 days agoJob DescriptionThe Records Reviewer is 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...

Responsibilities:Research, plan, develop, implement and evaluate training strategies, initiatives, and materials including comprehensive education programs to meet orientation and ongoing competency needs and professional development needsAssess data and information related to claim medical outcome and other pertinent situations including identification of...

Job Title : Team Lead (PHRN)Location : Taguig CitySalary Package65k monthly salary package100k signing bonusQualifications:At least 6 months to 2 years of TL/Coding experience or relevant expertiseFlexible to work on shifting schedule if business ask (weekends, night shift, holidays)Work On site, Blended (Voice and Non-Voice)Graduate of accredited Registered...

Educational Background: BS NursingQualifications: 8+ years of related experience or equivalent combination of education and experiencerequired to include 2+ years of direct clinical care OR 2+ years of casemanagement/utilization management required. Bachelor's degree in nursing (BSN) from accredited college or university or equivalentwork experience...

About Our Client One of the fastest growing digital banks in the ASEAN region. Job DescriptionDesign and implement robust, scalable, and maintainable iOS applications using Foundation, Core Data, UIKit, and SwiftUI.Strong understanding of clean architecture principles, SOLID principles, and domain-driven design (DDD).Utilize Foundation framework for...

Senior Leader for Clinical Services Operations Add expected salary to your profile for insights At least five years of supervisory/managerial experience working in Clinical services, such as Clinical Authorization, Utilization Management/Review, and Clinical Denials & Appeals. Prior experience Management experience with Clinical Documentation Integrity (CDI)...

Description Mission statement:Responsible for sales of Automation and Communication (AC) business within Power Grid Automation BU in accordance with strategy. Build long term customer relationships and manage resolution to specific customer needs and issues.Your responsibilities:You will support and grow Sales within Automation (Substation Protection and...

Job DescriptionAbbott Rapid Diagnostics is part of Abbott's Diagnostics family of businesses, bringing together exceptional teams of experts and industry leading technologies to support diagnostic testing which provides important information for treatment and management of diseases and other conditions. The position of Customer Service Associate 2 is located...

Job DescriptionAbbott Rapid Diagnostics is part of Abbott's Diagnostics family of businesses, bringing together exceptional teams of experts and industry leading technologies to support diagnostic testing which provides important information for treatment and management of diseases and other conditions. The position of Customer Service Associate 2 is located...

The Customer Service Associate II- (ADPI) is responsible for a variety of sales and customer support activities by providing product and service information, resolving service inquiries and problems for internal and external customers. This position is responsible for the adherence of all procedures and Service Level Agreements (SLAs) established by Abbott...

Educational Background: B.S NursingQualifications: 8+ years of related experience or equivalent combination of education and experiencerequired to include 2+ years of direct clinical care OR 2+ years of casemanagement/utilization management required. Bachelor's degree in nursing (BSN) from accredited college or university or equivalentwork experience...

Key skills manger operations Healthcare domain Healthcare Operation PH Healthcare Minimum 2 years leadership role in BPO Healthcare Healthcare account BPO Healthcare.Functional Title: Operations Manager.Educational Background: B.S NursingQualifications: 8+ years of related experience or equivalent combination of education and experience required to include...

The Regional Manager is responsible for independently planning and managing the execution of the APAC Compliance Testing plan ensuring appropriate testing coverage of the region's Compliance risk as dictated by the relevant Compliance Risk Assessments. Responsibilities Independently draft the testing plan for the current/upcoming year for APAC and seek...

The position works with the Software Support Manager to keep all team members focused on team and department goals. The overarching goal of the position is to increase client confidence due to longevity of staff, quality of answers provided, and continually improving service. This results in clients who feel more ownership and control over the product and...