Utilization Reviewer

Utilization Reviewer Job Description:We are seeking a highly skilled Utilization Reviewer to join our team at Gratitude Philippines. As a Utilization Reviewer, you will play a critical role in reviewing medical treatments to ensure that they are necessary and delivered effectively. Your expertise in utilization review will enable you to identify potential...

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...

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...

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...

Job Description:The Clinical Utilization Review Specialist is a critical role at Gratitude Philippines, responsible for ensuring that medical treatments are necessary and delivered effectively. As a key member of our team, you will work closely with claims adjusters to review treatment authorization requests based on state guidelines and medical...

We are looking for a seasoned Utilization Review and Improvement Expert to join our team at Gratitude Philippines. This role demands a high level of proficiency in analyzing and managing complex cases, leveraging extensive knowledge of medical procedures, regulatory compliance, and best practices in healthcare.The successful candidate will bring a unique...

Company OverviewGratitude Philippines is a healthcare organization that provides quality services to its clients. Our team of professionals is dedicated to delivering exceptional care and support.SalaryThe salary range for this position is 30-50K per annum, depending on experience. Job DescriptionWe are seeking a skilled RN with at least 5 years of...

Job DescriptionWe are seeking a highly skilled RN Case Management Professional to join our team at Gratitude Philippines. As a key member of our healthcare team, you will be responsible for managing the care of patients with complex medical conditions.The ideal candidate will have 5+ years of experience in utilization management review or clinical appeals...

Oracle Utilities Functional ArchitectJob DescriptionConduct and attend workshops with the client for a specific/multiple workstreams.Understand business requirements and/or high-level designs from clients/stakeholders and provide high-level estimates.Manage and monitor projects to ensure that delivery schedule is on target, defined milestones are met,...

Company Overview:At DDT Konstract Inc., we are committed to delivering top-notch infrastructure projects that meet the highest standards of quality and safety.We are seeking a highly skilled MEPFS Engineer to join our team in Paranaque City. As a key member of our project team, you will be responsible for ensuring the smooth coordination of MEPFS works with...

About UsWe are a leading recruitment agency specializing in placing top talent in the power industry. We work closely with our clients to understand their unique needs and requirements, and we take pride in delivering high-quality candidates who meet and exceed expectations. Role OverviewThis is an excellent opportunity for a seasoned financial professional...

At Gratitude Philippines, we value expertise and dedication. Our Utilization Reviewer position requires a highly qualified professional with a deep understanding of clinical experience and case management practices. As a Clinical Experience Specialist, you will leverage your knowledge to support informed decision-making within our organization.The successful...

Company ProfileAt Gratitude Philippines, we are committed to providing exceptional healthcare services to our clients. We believe in the importance of compassion, empathy, and excellence in everything we do. About the RoleWe are seeking a highly skilled RN to join our team as a healthcare utilization manager. In this role, you will be responsible for...

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,...

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,...

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

**Job Summary:**We are seeking a highly skilled Senior Quality Assurance Specialist to join our team at Gratitude Philippines. The successful candidate will be responsible for conducting quality assurance oversight activities, reviewing managed care internal and external claim files, and analyzing quality assurance reporting metrics.**Key...

Key ResponsibilitiesWe are seeking a highly skilled Healthcare Utilization Manager to join our team at Gratitude Philippines. As a key member of our healthcare team, you will be responsible for ensuring that patients receive high-quality, effective care.The ideal candidate will have 5+ years of experience in utilization management review or clinical appeals...

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...