Utilization Review Nurse

Utilization Review CoordinatorJOB 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...

Overview Utilization Review Coordinator position at Health Business Solutions. This role oversees patient insurance certification, compliance with governmental regulations related to hospital stays, and the prevention of denials. The Utilization/Risk Management department conducts perspective, concurrent, and retrospective reviews for authorization of Levels...

Job OverviewThis is a professional opportunity to support our Residential, PHP, and IOP levels of care. We are seeking a detail-oriented Clinical Review Specialist who will be responsible for conducting peer reviews, case consultations, and interfacing with insurance payers to obtain continued authorization.The ideal candidate will be a licensed clinical or...

Explore clinical claim review and pre-service review RN jobs in Muntinlupa, where healthcare opportunities are expanding. These roles involve assessing medical claims, ensuring accuracy, and verifying pre-authorization requirements. Professionals in this field play a crucial part in maintaining healthcare standards and optimizing resource allocation. In...

About the job Registered Nurse - Associate We are seeking a detail-oriented and compassionate PHRN Associate to join our healthcare support team. The ideal candidate is a Philippine-licensed Registered Nurse (PHRN) who will provide clinical support for healthcare processes such as utilization management, medical review, claims processing, or telehealth...

Overview Join to apply for the USRN BPO - Utilization Review Supervisor role at NTT DATA North America Responsibilities Manages a staff of professional-level team members or manages a team through lower-level supervisors manging healthcare Payer claims adjudication process Works within general policies and management guidance, independently determining...

Job Title: Virtual Utilization Review Specialist">At Nezda Technologies Inc., we are seeking a skilled Virtual Utilization Review Specialist to join our team. In this role, you will be responsible for assessing and interpreting customer needs, requirements, and medical records.>Key Responsibilities:">Review medical claims for medical necessity;Assess and...

Registered Nurse Quality Assurance QA Reviewer Job posted today. This position is in Navotas City. Job Description Qualifications Graduate of BS Chemistry, BS Chemical Engineering, BS Food Technology or related course (professional licensure or relevant certification is an advantage). At least two (2) years of related experience as QAC staff in a food...

Makati, National Capital Region Peregrine Eye and Laser Institute Posted today Registered Nurse - Makati Job Description This position is responsible for assisting medical doctors in providing quality eye care treatment to patients. No working experience is required. Job Types : Full-time, Permanent Benefits : Company events Employee discount ...

Overview Share Job Description Works in Quezon City - With relocation assistance* We are seeking a qualified Registered Nurse for our -voice account - BPO setting. Responsibilities You will extract and summarize relevant clinical information from patient records to support healthcare analytics, research, and quality improvement efforts. This role involves...