Oncology & Musculoskeletal Medical Specialist

1 month ago


Manila, National Capital Region, Philippines Private Advertiser Full time

Collaborate with healthcare providers and members to promote quality member outcomes, optimize benefits, and resource utilization.

Collaborate with medical directors to interpret appropriateness of care and accurate claims payment. Manage appeals for services denied.

Key responsibilities include:

  • Conduct pre-certification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews.
  • Ensure member access to medically necessary, quality healthcare in a cost-effective setting.
  • Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high-quality, cost-effective care.
  • Collaborate with providers to assess member needs for early identification of and proactive planning for discharge planning.
  • Facilitate member care transition through the healthcare continuum and refer treatment plans/plan of care to clinical reviewers as required.
  • Facilitate accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.

Requirements:

  • BSN, current active unrestricted RN license to practice as a health professional in applicable state(s) of the United States.
  • 2 years of acute care clinical experience or case management, utilization management or managed care experience.
  • Healthcare related certification and/or Master's degree a plus.

Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills are required.


  • Product Specialist

    4 weeks ago


    Manila, National Capital Region, Philippines I.E. Medica Inc. Full time

    Product Specialist (Oncology) job involves promoting and selling oncology products to healthcare professionals, requiring a deep understanding of oncology treatments and effective communication skills. The role involves working closely with sales operations and medical affairs to position products strategically in the market. About the Job Develop...

  • Medical Specialist II

    3 weeks ago


    Manila, National Capital Region, Philippines Valenzuela City Medical Center - Government Full time

    Medical Specialist II - Part Time in NCRJob Summary: A Medical Specialist II will perform medical examinations and provide medical advice to patients in a part-time capacity.Key Responsibilities: Conduct medical examinations and assessments Provide medical advice and treatment options Develop and implement patient care plans Collaborate with healthcare...

  • Medical Specialist II

    4 weeks ago


    Manila, National Capital Region, Philippines Valenzuela City Medical Center - Government Full time

    Medical Specialist II - Part Time in NCR Summary: Medical Specialist II provides medical services to patients in a part-time capacity, working closely with healthcare teams to deliver high-quality patient care. For this role, you will be responsible for: Providing medical services to patients in a part-time capacity Working closely with...

  • Medical Specialist II

    4 weeks ago


    Manila, National Capital Region, Philippines Valenzuela City Medical Center - Government Full time

    Seeking Medical Specialist II - Part Time in NCR. For full job details, please see PDF file on Civil Service Commission site. To proceed, kindly follow the procedure described in the PDF file. This part-time role requires a medical specialist to provide high-quality patient care in a dynamic and fast-paced environment. Key responsibilities include conducting...

  • Product Specialist

    4 weeks ago


    Manila, National Capital Region, Philippines I.E. Medica Inc. Full time

    Job Summary: Promote and sell oncology products to healthcare professionals, driving market growth and expanding product share.The Product Specialist (Oncology) plays a key role in our company's mission to provide innovative solutions for cancer treatment. This position requires a deep understanding of oncology treatments, disease states, and the ability to...


  • Manila, National Capital Region, Philippines Accustandard Medical and Diagnostic Supplies Full time

    Job Title: Account SpecialistAccustandard Medical and Diagnostic Supplies is seeking a highly motivated and results-driven Account Specialist to join our team.Key Responsibilities:Identify and close sales opportunities and potential projectsResponsible for the achievement of collection and objectivesPerform minor troubleshootingMaintain strong relationships...


  • Manila, National Capital Region, Philippines Career Professionals, Inc. Full time

    Job SummaryCareer Professionals, Inc. is seeking a skilled Medical Care Specialist to join our team. As a Medical Care Specialist, you will be responsible for administering medical services, including ECG and BP monitoring, for Preemployment (PE), Annual Physical Examinations, and consultations.Key ResponsibilitiesAdminister medical services, including ECG...


  • Manila, National Capital Region, Philippines JOB MATCHMAKER Full time

    Medical Aesthetic Specialist OpportunityWe are seeking a highly skilled Medical Aesthetic Specialist to join our team at JOB MATCHMAKER. The ideal candidate will have the following qualifications:Newly Board Passer candidates welcome to applyAt least 5 years of Aesthetic Training ExperienceSalary InformationSalary will be discussed during the interview...

  • Product Specialist

    3 weeks ago


    Manila, National Capital Region, Philippines I.E. Medica Inc. Full time

    Promote and sell oncology products to healthcare professionals, leveraging deep understanding of oncology treatments and disease states. Key responsibilities include developing product knowledge, building relationships with healthcare professionals, conducting educational presentations, and collaborating with the sales team.


  • Manila, National Capital Region, Philippines Rippedboxstation Full time

    About RippedboxstationWe are a dynamic company seeking a skilled Medical Support Specialist to join our team. As a key member of our staff, you will play a vital role in ensuring the smooth operation of our medical services.


  • Manila, National Capital Region, Philippines Recruiter PH Full time

    Key Responsibilities:As a Medical Coding Specialist at Recruiter PH, you will be responsible for ensuring accurate and efficient coding of outpatient medical records.Requirements:• Bachelor’s degree in Nursing• Certified Medical Coder (CCA, CPC, CCS, etc.)• No experience required• Proficient in coding systems (ICD, CPT, HCPCS)• Fluent in English...


  • Manila, National Capital Region, Philippines Addmore Outsourcing Inc. Full time

    We are seeking a Medical Transcription Specialist to join our team at Addmore Outsourcing Inc. The ideal candidate will possess a strong understanding of medical terminology, anatomy, and physiology.Key Responsibilities:Transcribe medical recordings into comprehensive written documents with high accuracy and attention to detail.Utilize knowledge of medical...


  • Manila, National Capital Region, Philippines GECO Philippines Full time

    Job Summary:GECO Philippines seeks a skilled Medical Coding Specialist to join our team.Main Responsibilities:Assign diagnosis codes according to the Official ICD-10-CM Guidelines for Coding and Reports for conditions which map to the Center for Medicare & Medicaid Services' Hierarchical Condition Categories (CMS-HCC) applicable for the year(s) of service...

  • Account Specialist

    4 weeks ago


    Manila, National Capital Region, Philippines Accustandard Medical and Diagnostic Supplies Full time

    Account SpecialistAccustandard Medical and Diagnostic Supplies is seeking a highly motivated and results-driven Account Specialist to join our team.Key Responsibilities:Identify and close sales opportunities and potential projectsResponsible for the achievement of collection and objectivesPerform minor troubleshootingMaintain strong relationships with key...


  • Manila, National Capital Region, Philippines ACTFA Medical & Laboratory Diagnostics Full time

    About the Role:We are seeking a skilled Diagnostic Imaging Specialist to join ACTFA Medical & Laboratory Diagnostics, responsible for operating sonographic scanners to capture high-quality images of patients' internal organs and expectant mothers' developing fetuses.As a Diagnostic Imaging Specialist, you will be responsible for a range of sonographic...


  • Manila, National Capital Region, Philippines ACTFA Medical & Laboratory Diagnostics Full time

    We are seeking a skilled Diagnostic Imaging Specialist to work in our medical facility. As an ultrasound technician, you will be responsible for operating sonographic scanners to capture images of patients' internal organs and expectant mothers' developing fetuses.Key Responsibilities:Explaining the ultrasound procedure to patients and providing...


  • Manila, National Capital Region, Philippines Med Supply US Full time

    Job Title: Medical Prior Authorization SpecialistAt Med Supply US, we are seeking a highly skilled Medical Prior Authorization Specialist to join our team. As a key member of our healthcare team, you will play a crucial role in ensuring that medical services, procedures, and medications are approved by insurance companies or third-party payers before they...


  • Manila, National Capital Region, Philippines IFIVE INC. Full time

    Medical Retrieval Specialist job requires gathering medical records, contacting facilities, and maintaining customer service skills. Responsibilities: Retrieve record evidence for cases. Submit medical records. Contact facilities to follow-up on requests for evidence. Dispute invoices. Distribute electronic records. ...


  • Manila, National Capital Region, Philippines Cliniqon Full time

    Hospice Billing Job DescriptionAt Cliniqon, we are seeking a highly skilled Medical Claims Specialist to join our team. As a key member of our healthcare revenue cycle team, you will be responsible for preparing and submitting accurate and timely billing claims for hospice services to Medicare, Medicaid, and private insurance companies.Key...


  • Manila, National Capital Region, Philippines Optum, a UnitedHealth Group Company Full time

    Job Summary: Medical Coding Specialist We're seeking a skilled Medical Coding Specialist to provide coding and auditing services to healthcare providers, translating medical diagnoses and procedures into designated numerical codes. As a Medical Coding Specialist, you will play a critical role in ensuring the accuracy and consistency of medical coding,...