Utilization Reviewer

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•...

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...

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...

We are seeking a highly skilled Clinical Utilization Review Specialist to join our team at Gratitude Philippines. This role is responsible for conducting thorough reviews of medical records to ensure compliance with regulatory requirements and company standards.Key Responsibilities:Conduct clinical reviews of medical records to determine medical necessity...

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...

Gratitude Philippines: A Leader in HealthcareWe are seeking a skilled Clinical Utilization Specialist to join our team in Taguig. As a key member of our healthcare team, you will play a vital role in reviewing and managing healthcare utilization.About the RoleUtilization Management Review:Clinical Appeals and Denials Handling for Healthcare...

Manpower Core Group Inc. is seeking a skilled Clinical Utilization Specialist - Medical Case Manager to join our team in BGC. This role plays a vital part in ensuring that employees receive the necessary medical care and support to return to work.About the Role:This position involves conducting thorough reviews of treatment authorization requests based on...

Responsibilities: 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,...

Responsibilities: 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,...

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: 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...

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 needs Assess data and information related to claim medical outcome and other pertinent situations including identification of...

* Provide advance level support, fulfillment of timelines and advice to users ensuring maximum availability, performance and utilization of knowledge and information systems.* Provide inputs for Problem management by leveraging best effort method for issue resolution through cross functional coordination and support team lead in training, reviews and...

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...

JOB TITLE: Total Compensation/ Compensation and Benefits WORK SETUP: Hybrid in Taguig WORK SHIFT: Dayshift/mid-shift • 10 years experience in solid background with C&B Position Description: C&B professional based out of Manila, Philippines with 10+ years of experience in managing core Compensation and Benefit activities and reports to the Regional...

Target and priority profiles: • 10 years experience in solid background with C&B Position Description: C&B professional based out of Manila, Philippines with 10+ years of experience in managing core Compensation and Benefit activities and reports to the Regional Head. Your future duties and responsibilities: • Compensation including Variable/Ownership...

Are you looking for a challenging role where you can utilize your skills to drive business growth? Tasq Staffing Solutions is seeking an experienced Highly Skilled Operations Support Specialist.As a key member of our team, you will provide advanced level support and ensure maximum availability, performance, and utilization of knowledge and information...

Job Description:">This Compensation and Benefits Specialist role is an excellent opportunity for an experienced professional to join a reputable organization in the Philippines. The successful candidate will be responsible for managing core compensation and benefit activities, including compensation planning, insurance benefits, and employee data...