Utilization Review Author

JOB PURPOSE: This position is responsible for clinical review of medical records against clinical guidelines (Interqual, MCG, CMS, etc.) to prove medical necessity of medical services provided to the patient and ensure maximum coverage through insurance benefits. PRIMARY DUTIES & RESPONSIBILITIES:Utilization Review Nurse duties include but are not limited...

QualificationsAt least 1 year of relevant BPO experience as a Utilization Review NursePHRN licensed Willing to report onsite and on a night shift scheduleJob DescriptionProvide health care utilization review services regarding admissions, observations, Discharge Wqs based on the payer types and review types. Review admissions and service requests within...

Job PurposeAuthorizations Management is a service delivery team that works to obtain prior authorizations and referrals for medical practices throughout the US. We work to take the burden off practices by initiating the authorization process as soon as providers order medical services. Job Duties and Responsibilities· Prioritize incoming authorization and...

Job Specifications:Graduate of Bachelor's Degree – RN License is required.Minimum of 2 years experience and must have impressive track record in reviewing treatment plans and services to ensure the efficient use of patient utilization systems and quality care using appropriate medical resources.Effective team playerExcellent interpersonal relationship...

POSITION: Prior Authorization SpecialistDEPARTMENT: Quality EnhancementREPORTS TO: Team Leader/ Claims AdjusterDIRECT REPORTS: NoneCORE VALUESThe core values of Office Symmetry Eligibility and Prior Authorization are dignity and stewardship. Each staff member is expected to perform their job duties in a way that preserves dignity for our patients and...

QualificationsAt least 1 year of relevant BPO experience as a Clinical Authorization SpecialistPHRN licensed Willing to report onsite and on a night shift scheduleResponsibilitiesContact insurance carriers to verify patient's insurance eligibility, benefits and requirements. Request, track and obtain pre-authorization from insurance carriers within time...

About Us:Outsourced. ph is a leading ISO-certified Philippines offshore outsourcing company that provides dedicated remote staff to some of the world's leading international companies. Outsourced is recognized as one of the Best Places to Work and has achieved Great Place to Work Certification. We are committed to providing a positive and supportive work...

With over 9,000 professionals across 12 delivery centers in the Philippines, MicroSourcing remains the country's largest offshoring solutions provider. PAR Writer, be 100% YOU with MicroSourcing A PAR Writer is expected to:Under the direct supervision of the Clinical Director, and in collaboration with the Clinical Team, this position is the key to the...

Candidate must possess at least a Bachelor's/College Degree (Nursing, Physical Therapy, or any paramedical/allied medical course preferred)With good written and oral communication skillsExcellent people skillsComputer literate in MS Excel, MS Word.Proficient in the English languageHighly motivatedBackground / experience in HMO setting / Medical Liaison will...

Job PurposeA Precertification Coordinator is responsible for obtaining prior authorizations on behalf of the provider's office for imaging services and surgeries. Job Duties and ResponsibilitiesPrioritize incoming authorization requests according to queue urgencyReview patient's clinical and chart documentation related to the service submitted by the...

JOB SUMMARY1. Overall Mechanical, Plumbing, Fire Protection and Sanitary design engineer knowledgeable in MPFS design standards.2. Review all drawings from MPFS consultants to check if in compliance with code, making sure the drawings and specifications are the most economical, efficient and optimal for our projects.3. Coordinate with MPFS consultants and...

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...

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...

Responsible for collaborating with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources. Ensures medically appropriate, high-quality, cost-effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic...

WE ARE IN NEED OF PHRNWork Location: Onsite in Ortigas QUALIFICATIONS:PHRN with active license 1 year prior auth OR Utilization Management OR Healthcare experience handling payer side/ provider side/ handling scheduling or any inbound process Amenable to work onsiteCan start ASAPSALARY:40,000 up to 50,000 By Applying, you give consent to collect, store,...

BENEFITS/PERKSCompetitive Salary13th and 14th month salary guaranteedPerformance Incentive Plan / Yearly BonusRetirement Program and Group Life InsuranceBe part of a pioneer teamKEY RESPONSIBILITIESKey responsibilities will include, but are not limited to, the following:Preauthorization of in-patient treatment.Aggressive cost containment through tight...

Process off-island (PI) referral for necessary consultation/examination and facilitate prompt triage and processing of off-island concerns of walk-in/call-in members with or without a valid off-island pre-certification form issued by appropriate Informed Choice personnel both from Guam and Saipan.Assist in the processing and issuance of Letters of...

Job Qualifications:Education: Graduate of a medical course or any related field.Experience: At least 6 months of experience in Healthcare BPO, medical, or pharmacy.EMR Experience: Experience with Electronic Medical Records (EMR) systems such as EPIC is advantageous.Medical Terminology Knowledge: Understanding of medical procedures, treatments, and...

Job Title: Technical Director Join our team as a Technical Director and take on a key role in shaping the future of our organization. As a Technical Director, you will provide technical direction, guidance, and resources to our staff on a daily basis. Key Responsibilities: Develop and implement UM quality initiatives, ensuring alignment with...

This role is an open-end contract position with a hybrid work setup. Please apply only if you are amenable to these terms.The Clinical Document Specialist assists in clarifying documentation regarding patient diagnoses and/or procedures, co-morbid conditions, complications, and any other related data for reporting. The work involves the use of proprietary...