Medical Case Manager
5 days ago
Roles and Responsibilities:• PH Registered nurses to review workers compensation claims with serious injury and that need surgery/lengthy treatments, create a return-to-work plan, work with various stakeholders (medical providers, injured worker, employer, attorney) to track the treatment plan and help bring the injured worker back to work.• Nurses have continuous communication with injured workers and as a single point of contact for the injured workers• Uses clinical/nursing skills to determine whether all aspects of a patient’s care, at every level, are medically necessary and appropriately delivered.• Sends letters as needed to prescribing physician(s) and refers to physician advisor as necessary• Responsible for accurate comprehensive documentation of case management activities in case management system.• Uses clinical/nursing skills to help coordinate the individual’s treatment program while maximizing quality and cost-effectiveness of care including direction of care to preferred provider networks where applicable.• Addresses need for job description and appropriately discusses with employer, injured employee and/or provider. Works with employers on modifications to job duties based on medical limitations and the employee’s functional assessment.• Responsible for helping to ensure injured employees receive appropriate level and intensity of care through use of medical and disability duration guidelines, directly related to the compensable injury and/or assist adjusters in managing medical treatment to drive resolution.• Communicates effectively with claims adjuster, client, vendor, supervisor, and other parties as needed to coordinate appropriate medical care and return to work.• Performs clinical assessment via information in medical/pharmacy reports and case files; assesses client’s situation to include psychosocial needs, cultural implications, and support systems in place.• Objectively and critically assesses all information related to the current treatment plan to identify barriers, clarify, or determine realistic goals and objectives, and seek potential alternatives.• Partners with the adjuster to develop medical resolution strategies to achieve maximal medical improvement or the appropriate outcome.• Evaluate and update treatment and return to work plans within established protocols throughout the life of the claim.• Engage specialty resources as needed to achieve optimal resolution (behavioral health program, physician advisor, peer reviews, medical director).• Partner with adjuster to provide input on medical treatment and recovery time to assist in evaluating appropriate claim reserves.• Keeps current with market trends and demands.• Performs other functionally related duties as assigned.Required Qualifications:• Bachelor’s degree in nursing (BSN)• Active unrestricted RN license that can be validated thru PRC website• 1-2 years of relevant Clinical experience in any medical/surgical department, Orthopedic, Medical/Surgical ICU, Coronary Care Unit (CCU), Rehabilitation, Emergency department• Written and verbal fluency in English• Candidate should be willing to work onsite (BGC)• Candidate should be willing to work in US operation hours
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Medical Case Manager
5 days ago
Taguig, Philippines Gratitude Philippines Full timeRoles and Responsibilities: • PH Registered nurses to review workers compensation claims with serious injury and that need surgery/lengthy treatments, create a return-to-work plan, work with various stakeholders (medical providers, injured worker, employer, attorney) to track the treatment plan and help bring the injured worker back to work. • Nurses...
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Medical Case Manager
5 days ago
Taguig, Philippines Gratitude Philippines Full timeRoles and Responsibilities: • PH Registered nurses to review workers compensation claims with serious injury and that need surgery/lengthy treatments, create a return-to-work plan, work with various stakeholders (medical providers, injured worker, employer, attorney) to track the treatment plan and help bring the injured worker back to work. • Nurses...
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Disability Case Manager
5 days ago
Taguig, Philippines Recruiter PH Full time- Adjudicate disability for eligibility of short and long-term benefits. This includes reviewing and analyzing contractual, medical, functional and occupational information- Coordinate appropriate interventions including, but not limited to: Independent Medical Evaluations, Functional Capacity Evaluations, Ergonomic assessments, Medical Consultant Opinions,...
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Disability Case Manager
5 days ago
Taguig City, Philippines Recruiter PH Full time- Adjudicate disability for eligibility of short and long-term benefits. This includes reviewing and analyzing contractual, medical, functional and occupational information - Coordinate appropriate interventions including, but not limited to: Independent Medical Evaluations, Functional Capacity Evaluations, Ergonomic assessments, Medical Consultant Opinions,...
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Disability Case Manager
5 days ago
Taguig City, Philippines Recruiter PH Full time- Adjudicate disability for eligibility of short and long-term benefits. This includes reviewing and analyzing contractual, medical, functional and occupational information - Coordinate appropriate interventions including, but not limited to: Independent Medical Evaluations, Functional Capacity Evaluations, Ergonomic assessments, Medical Consultant Opinions,...
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Disability Case Manager
5 days ago
Taguig, Philippines RecruiterPH Full timeWhat will you do?o Adjudicate disability for eligibility of short and long-term benefits. This includes reviewing and analyzing contractual, medical, functional and occupational informationo Coordinate appropriate interventions including, but not limited to: Independent Medical Evaluations, Functional Capacity Evaluations, Ergonomic assessments, Medical...
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Disability Case Manager
5 days ago
Taguig City, Philippines RecruiterPH Full timeWhat will you do? o Adjudicate disability for eligibility of short and long-term benefits. This includes reviewing and analyzing contractual, medical, functional and occupational information o Coordinate appropriate interventions including, but not limited to: Independent Medical Evaluations, Functional Capacity Evaluations, Ergonomic assessments, Medical...
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Disability Case Manager
5 days ago
Taguig City, Philippines RecruiterPH Full timeWhat will you do? o Adjudicate disability for eligibility of short and long-term benefits. This includes reviewing and analyzing contractual, medical, functional and occupational information o Coordinate appropriate interventions including, but not limited to: Independent Medical Evaluations, Functional Capacity Evaluations, Ergonomic assessments, Medical...
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Quality Assurance Specialist
5 days ago
Taguig, Philippines Gratitude Philippines Full timeResponsibilities: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,...
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Trainer - Medical Education Specialist
5 days ago
Taguig, Philippines Gratitude Philippines Full timeResponsibilities: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...
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Quality Assurance Specialist
5 days ago
Taguig, Philippines Gratitude Philippines Full timeResponsibilities: Carry out quality assurance oversight activities defined in the Client Managed Care National Best Practices and Quality Assurance Standards Conduct 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,...
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Trainer - Medical Education Specialist
5 days ago
Taguig, Philippines Gratitude Philippines Full timeResponsibilities: 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 needs Assess data and information related to claim medical outcome and other pertinent situations including identification of...
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Quality Assurance Specialist
5 days ago
Taguig, Philippines Gratitude Philippines Full timeResponsibilities: Carry out quality assurance oversight activities defined in the Client Managed Care National Best Practices and Quality Assurance Standards Conduct 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,...
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Trainer - Medical Education Specialist
5 days ago
Taguig, Philippines Gratitude Philippines Full timeResponsibilities: 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 needs Assess data and information related to claim medical outcome and other pertinent situations including identification of...
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Medical Consulting Manager
5 days ago
Taguig, Philippines JKILC Full timeCOMPANY PROFILE: This company have been the world leader for nearly 34 years. They specialize in technology software, research and development. This company is part of a global network known for innovation and expertise, delivering services that empower clients to excel as high-performance entities. Position: Medical Consulting Manager Company Industry:...
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Medical Consulting Manager
4 days ago
Taguig, Philippines JKILC Full timeCOMPANY PROFILE: This company have been the world leader for nearly 34 years. They specialize in technology software, research and development. This company is part of a global network known for innovation and expertise, delivering services that empower clients to excel as high-performance entities. Position: Medical Consulting Manager Company Industry:...
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Medical Consulting Manager
5 days ago
Taguig, Philippines JKILC Full timeCOMPANY PROFILE: This company have been the world leader for nearly 34 years. They specialize in technology software, research and development. This company is part of a global network known for innovation and expertise, delivering services that empower clients to excel as high-performance entities.Position: Medical Consulting ManagerCompany Industry: BPO/IT...
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Operations Manager
5 days ago
Taguig, Philippines Gratitude Philippines Full timeEducational Background: B.S Nursing Qualifications: 8+ years of related experience or equivalent combination of education and experience required to include 2+ years of direct clinical care OR 2+ years of case management/utilization management required. Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work...
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Utilization Reviewer
5 days ago
Taguig, Philippines Gratitude Philippines Full timeRoles 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...
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Utilization Reviewer
5 days ago
Taguig, Philippines Gratitude Philippines Full timeRoles 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...
