usrn and phrn with umr experience

Seeking a detail-oriented and organized professional to manage UMR and pre-auth processes, with a strong understanding of medical necessity guidelines and denials. **Job Summary:** We are looking for a skilled PHRN or USRN to join our team, with a strong background in clinical experience and knowledge of UMR and pre-auth processes. ...

MUST BE PHRN 2 yrs w/o clinical experienceMinimum 1 yr UMR and or pre auth experience with knowledge of denials and medical necessity guidelines-1 yr w/ clinical experience (bedside Medical Surgical, ER or OR)-1yr BPO w/ clinical experience or 2yrs BPO w/o clinical experience Offer :PHRN UMR- up to 50k package Temp WFH USRN UMR - up to 75k ( onsite )

AVAILABLE POSITIONSUtilization Management Reviewer - At least 1 yr experience as UMR + 6 mos clinical/hospital experience (PHRN)Clinical Authorization Specialist - At least 1 yr background in Clinical Authorization + 6 mos clinical/hospital experience (Non-Registered Nurses are welcome to apply)Clinical Team Leader - At least 5 years of relevant BPO...

Get a comprehensive NCLEX review and exam preparation program with a monthly allowance and potential promotion to a USRN position with increased compensation. Our dynamic team is dedicated to helping Philippine Registered Nurses (PHRNs) achieve their dream of becoming US Registered Nurses (USRNs). We offer a comprehensive NCLEX program designed to provide...

Company Overview:Join our dynamic team dedicated to helping Philippine Registered Nurses (PHRNs) achieve their dream of becoming US Registered Nurses (USRNs). We offer a comprehensive NCLEX program designed to provide free review and exam preparation for 3-6 months, with a focus solely on the review process.As a participant in our program, you'll receive up...

Job Summary: Experienced process trainer sought to develop and implement clinical capability development trainings for frontline staff in a healthcare vertical account. Key Responsibilities: Conducts new hire interviews and provides feedback to operations Develops and implements effective systems for process updates and training curriculum Provides...

If interested, you may now apply using this Workday link below: About usR1 is a leading provider of technology-driven solutions that transform the patient experience and financial performance of healthcare providers. R1's proven and scalable operating models seamlessly complement a healthcare organization's infrastructure, quickly driving sustainable...

Cognizant is a global organization serving clients across multiple industries with a deep set of offerings provided by our practice areas and supported by corporate and enabling functions. Employing roughly 270,000 talented associates worldwide, Cognizant is dedicated to anticipating and solving clients' toughest problems and enabling them to thrive in the...

Seeking a BPO PHRN Quality Analyst/Trainer/Team Leader with 1-2 years of experience in healthcare processes and quality assessment. Job Description: Evaluate healthcare calls and transactions to ensure quality standards. Perform end-to-end quality assessments, provide feedback and coaching to team members, and identify areas for improvement....

QualificationsAt least 1 year of relevant BPO experience as a Clinical Denials and Appeals NurseMinimum of 6 mos hospital experiencePHRN licenseWilling to report onsite (McKinley West, Taguig) and on a night shift scheduleResponsibilitiesEffectively review inpatient and/or outpatient medical necessity and authorization denials to determine and understand the...

Job Description: BPO PHRN Quality Analyst/ Trainer/ Team leader. Location: Pasig City, Metro ManilaSalary: PHP 550, ,000 per month + 10% night differentialType: 100% Onsite, Graveyard Shift, Shifting ScheduleAvailability: Immediate StartResponsibilities:Evaluate and monitor healthcare calls and transactions to ensure adherence to quality standards.Perform...

Job Duties and Responsibilities· Prioritize incoming authorization and referral requests according to queue urgency· Review patient's clinical and chart documentation related to the service submitted by the provider's office· Obtain and/or follow up on authorization and referral requests from the patient's payer/s through any of the following...

Make your next big career move by applying as KMC Solutions' next PHRN CLINICAL DENIALS AND APPEALS NURSE (PHRN)The main responsibilities of a PHRN CLINICAL DENIALS AND APPEALS NURSE (PHRN) include:Effectively review inpatient and/or outpatient medical necessity and authorization denials to determine and understand the validity of such denials in a timely...

Registered Nurse with clinical experience sought to review claims for appropriateness of care or coverage and work directly with clients to provide input under program policy or procedural requirements. Key Responsibilities: Apply medical judgment to adjudication of cases/claims. Review requests for denial reconsideration and appeals. ...

We are hiring for USRN - Utilization Review Author Rewarding Sign On Bonus Awaits You- Get as much as TWICE your monthly basic salary If interested, you may now apply using this Workday link below: Qualifications:Bachelor of Science in NursingMust have an active USRN Mainland LicenseAt least 2 years of recent hospital-based Utilization Review experience or...

Responsibilities:Responsible for training A&G clinical staff on processes, policies, and systemsParticipate & lead in the development, implementation, and updating of training manuals to reflect new approaches to training, departmental and/or system process changes and MCG criteria updates as neededOversee and mentor new employees during the initial training...

Job Summary: The Appeal Writer reviews denied insurance claims, creates appeal letters, and manages workflow to support claim payment. The Appeal Writer plays a crucial role in supporting our client hospitals by reviewing denied insurance claims and creating appeal letters to secure payment. This position requires strong writing skills, attention to detail,...

We are looking for a highly motivated professional who is well versed in clinical knowledge, healthcare staffing, people leadership and compliance. This role will interview nurse applicants and provide clinical insight on items relating to traveler documentation as well as provide education and expert interpretation for internal and external customers.Job...

Key Responsibilities Manage and audit medical bills and records. Validate coding (ICD/PT/DRG) and apply fee schedules. Negotiate provider fees and leverage costsaving opportunities. Provide clinical support and training to Medical Services Representatives. Contribute to the development of the Clinical Bill Review program.Qualifications Must have an Active...

ROLE AND RESPONSIBILITIESAudits within the DRG Validation Audit Program involve determining whether coding on a claim submission is supported by medical record documentation.They also check if the codes are in accordance with industry coding standards as outlined by the Official Coding Guidelines, the applicable ICD Coding Manual, and/or Coding Clinics. Your...