Utilization Review Coordinator
6 days ago
JOB SUMMARY We are seeking a skilled Utilization Review Coordinator (URC) to oversee patient insurance certification, compliance with governmental regulations related to hospital stays, and the prevention of denials. Embedded within our utilization review management platform are clinical criteria guidelines, streamlining the review and documentation process. The Utilization/Risk Management department conducts perspective, concurrent, and retrospective reviews for authorization of Levels of Care (LOCs) and services, engaging with Program Managers, reviewing medical necessity records, and liaising with individuals and their families when necessary. Additionally, the department handles billing and payroll functions. PRIMARY RESPONSIBILITIES Evaluate patient records to assess severity of illness and intensity of service. Apply medical necessity screening criteria and clinical knowledge to ensure appropriateness of admissions and length of stays. Conduct initial admission, continuing stay, and 23-hour observation reviews for all patients. Manage case reviews in the electronic utilization review system. Collaborate with payor sources to communicate clinical information and secure hospital reimbursement. Consult with physicians and nursing staff. Participate in interdisciplinary care rounds for effective communication with the care team. Use escalation pathways to resolve identified issues. Document all activities and interactions in the electronic utilization review record. Enhance customer satisfaction among patients, families, physicians, internal and external partners, payors, and vendors. Submit Initial and Concurrent Authorizations to insurance companies. Verify client insurance coverage for authorization submission. Coordinate with insurance companies to resolve billing or authorization issues. Communicate Billing and Payroll questions from Program Managers and ensure accurate documentation before billing claims. Review Service Verification Forms and Time sheets to ensure precise payroll processing. Participate in state and local audits. Adhere to policies, procedures, regulations, and standards governing the agency. Maintain strict confidentiality according to Federal and State guidelines. Uphold the Professional Code of Ethics. Other duties as assigned. QUALIFICATIONS Required: Bachelor’s degree in nursing, physical therapy, medical technician, HIMS, or a related medical field. Managed Care or Health Plan experience. Detail-oriented. Effective oral and written communication skills. Moderate computer proficiency – Microsoft Office Suite. Team-oriented approach. Independent functioning and autonomy. Strongly preferred qualifications: Previous experience in utilization review/management. Experience with InterQual and/or Milliman Care Guidelines. #J-18808-Ljbffr
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Utilization Review Coordinator
3 weeks ago
Manila, Philippines Health Business Solutions Full timeJob Summary We are seeking a skilled Utilization Review Coordinator (URC) to oversee patient insurance certification, compliance with governmental regulations related to hospital stays, and the prevention of denials. Embedded within our utilization review management platform are clinical criteria guidelines, streamlining the review and documentation process....
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Utilization Review Coordinator
2 days ago
Manila, National Capital Region, Philippines Health Business Solutions Full timeJOB SUMMARYWe are seeking a skilled Utilization Review Coordinator (URC) to oversee patient insurance certification, compliance with governmental regulations related to hospital stays, and the prevention of denials. Embedded within our utilization review management platform are clinical criteria guidelines, streamlining the review and documentation process....
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Utilization Review Nurse
6 days ago
Manila, Philippines Health Business Solutions LLC Full timeUtilization Review Nurse Location: Philippines About Us: HBiz is a leading Revenue Cycle Management (RCM) company dedicated to helping healthcare providers optimize their financial performance. We specialize in delivering innovative solutions that streamline revenue cycle operations and enhance overall revenue generation for healthcare organizations. Our...
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PHRN - Utilization Review
2 days ago
Manila, National Capital Region, Philippines PMConsulting Full time ₱600,000 per yearYou'll be responsible for reviewing medical records and clinical documentation todetermine the medical necessity, appropriateness, and efficiency of healthcare servicesprovided. You'll work closely with physicians, case managers, and insurance providers toensure optimal patient care while supporting cost containment efforts.Job Types: Full-time,...
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Southern Manila District, Philippines access healthcare Full timeUtilization Management Specialist (PHRN / Non-Voice) Join our dynamic healthcare team and make an impact by improving patient outcomes, ensuring compliance, and driving efficient healthcare delivery for our global clients. ✅ Ideal Candidate Must be a Philippine Registered Nurse (PHRN) with an active license. 1–2 years of experience in Utilization Review,...
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Medical Review Representative
2 days ago
Manila, Metro Manila, Philippines TakeCare Insurance Company Full time ₱900,000 - ₱1,200,000 per yearJob Specifications:1. Graduate of Bachelor's Degree – RN License is required.2. Minimum of 1 year experience and must have impressive track record in collecting, processing and monitoring routine to moderate complex referrals and health care services data and reviewing treatment plans and services in order to ensure the efficient use of...
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Home Loan Review Coordinator
2 days ago
Manila, National Capital Region, Philippines Addisons Advisory Group Full time ₱40,000 - ₱80,000 per yearThe Home Loan Review Coordinator plays a key role in supporting clients to maximise their property equity and achieve their financial goals. This position involves conducting regular reviews of home loan portfolios, identifying opportunities for refinancing, and ensuring compliance with lending policies and regulations.Key ResponsibilitiesConduct periodic...
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Digital Leader, Water Utilities
1 week ago
Manila, Philippines Aurecon Group Full time.Digital Leader, Water Utilities page is loaded## Digital Leader, Water Utilitiesremote type: Hybridlocations: Manilatime type: Full timeposted on: Posted Todayjob requisition id: R31381**Just imagine your future with us…**Diversity is at the core of everything we do. We work together to create a culture based on respect, trust, and inclusiveness. Our...
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Southern Manila District, Philippines Access Healthcare Services Manila, Inc. Full timeWe are seeking a highly skilled and detail-oriented PH Registered Nurse (PHRN) to join our team. The ideal candidate will have hands-on experience with InterQual , MCG , NCD , and LCD Guidelines . Key Responsibilities Conduct clinical reviews of inpatient and outpatient services using InterQual, MCG, NCD, and LCD criteria. Analyze patient records to...
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Water Utility Engineer
2 days ago
Manila, National Capital Region, Philippines Megaworld Corporation Full time ₱400,000 - ₱800,000 per yearGraduate of Mechanical Engineering course with applicable professional licenseWith more than 3 years of relevant work experienceExperience on coordination with water utility providers or related industryExcellent communication and interpersonal skills to collaborate with various utility providers and other stake holdersKnowledge of utility systems,...
