Clinical Case Manager

Key ResponsibilitiesThe Clinical Case Manager will be responsible for:Performing initial and concurrent review of inpatient cases applying MCG criteria or InterQual Criteria for approval and sending to Medical Directors if review is necessary for determining an adverse determination.Discussing cases with facility healthcare professionals to obtain...

At BrightCare Assist Philippines Inc, we are seeking a highly skilled Clinical Case Manager to join our team. As a key member of our healthcare coordination unit, you will be responsible for managing patient cases and ensuring smooth claims processing.What You Will Do:Coordinate with healthcare providers and insurance companies to facilitate patient care and...

Nezda Technologies Inc. is currently hiring for Clinical Nurse Case Manager - USRN.Salary: P 50,000 - P 68,000 (with Perks and benefits).Work Set up: Work From HomeQualifications:Active and Non-Active USRN License.With at least 1 Year Clinical or Hospital Experience.USRN with RN License.Job Description:We are in partnership with multiple companies for this...

The Case Manager Nurse will regularly liaise with multiple clinical specialties and doctors. This role also involves consistent interactions with insurance providers, patients and their families, legal delegates, and representatives from other medical care institutions. Additionally, they will often communicate with nursing staff, billing teams, medical...

Job DescriptionThe Medical Oncology Case Manager position at Vee Technologies Philippines requires a skilled professional to coordinate patient care and manage clinical workflows. The successful candidate will liaise with multiple clinical specialties, doctors, insurance providers, patients, families, legal delegates, and representatives from other medical...

Nurse Case Managers at UnitedHealth Group are dedicated to helping people live healthier lives and making the health system work better for everyone. As a member of our team, you will have the opportunity to work collaboratively with healthcare professionals to develop and implement individualized care plans that meet the unique needs of each patient. We are...

At Limitlessli we specialize in recruiting, hiring, and managing high-caliber remote staff for dynamic and growing healthcare facilities. Leveraging our extensive global network, we connect clients with highly qualified professionals, offering tailored services to meet our clients' unique business needs.The Opportunity:Are you a healthcare professional with...

Transform Your Clinical Expertise into a Key Role in Digital DentistryAre you looking to use your dental knowledge in a new, innovative way? As a Dental Case Management Specialist, you'll be at the heart of a cutting-edge digital dentistry process.You'll work closely with dental professionals and labs, ensuring every dental case submitted is processed...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. Our team plays a vital role in improving health outcomes by connecting individuals with the care, pharmacy benefits, data and resources they need to thrive. As a Clinical Utilization Specialist, you will join a diverse and inclusive culture...

As a Clinical Coordinator, you will play a vital role in ensuring that patients receive top-notch care and support every step of the way. You will work closely with our US-based healthcare client to provide comprehensive case management services.The Key Requirements:A valid USRN - NY nursing licenseA graduate degree in BS Nursing or similar fieldMinimum 2...

About the Role:We are seeking a skilled Nurse Case Manager - Medical Necessity to join our team at Omega Healthcare Management Services Inc. The successful candidate will have experience in reviewing denied claims and determining the validity of denials.The ideal candidate will have a strong understanding of medical necessity and billing procedures, as well...

Job Summary:At Omega Healthcare Management Services Inc., we are seeking a highly skilled Clinical Appeals Specialist to join our team. As a key member of our appeals team, you will be responsible for reviewing denied insurance claims and determining the validity of denials.The successful candidate will have experience in clinical nursing or case management,...

Job Description:Our team seeks an experienced Nurse - Clinical Case Management Specialist to coordinate the administration of disembarked crew member medical cases.This includes approval and reimbursement requests, and notices regarding unfit, fit-to-travel, fit-to-fly, and fit-to-work status.You will address queries or concerns raised during the case...

Key ResponsibilitiesPre-Employment Medical Examinations (PEME) Screening:Conduct thorough reviews of Pre-Employment Medical Examinations (PEME) to ensure they comply with company standards.Identify areas where information is lacking or incongruent with company guidance and escalate where necessary.Respond to MSC approved medical examiners, agencies, or...

Company Overview:MSC Crewing Services Philippines, Inc. is a leading provider of healthcare services to the maritime industry.We are seeking a highly skilled Healthcare Provider Liaison to join our team.Your primary responsibility will be to update and load documentation related to crew member Seafarer Medical Certificates and return-to-work reviews.Maintain...

You will be a practitioner on our telehealth platform 'Intellect', where your role is to support our clients' mental health and personal growth based on the individual needs and goals. This is delivered primarily through scheduled 60-minute video sessions on our platform.This is a freelance remote role with the flexibility to decide your business hours....

AVIGNON LASERDERM LIFESTYLE CORP. is looking for a dependable Clinic Manager who will be in charge of the day-to-day operations of the branch. They will manage client relationships by providing excellent customer service. The Clinic Manager will oversee the entire clinical team to achieve daily, weekly, and monthly targets.DUTIES AND...

Access Healthcare is looking for a Utilization and Clinical Denials Nurse to join our growing clinical account. The ideal candidate is a Licensed Philippines Nurse with at least one (1) year of hospital bedside experience and a strong understanding of utilization review, clinical documentation, and denial management in a BPO set-up. This role involves...

About the roleWe are seeking an experienced Clinic Manager to oversee the day-to-day operations of our healthcare clinic in Makati City, Metro Manila. As a full-time role, you will be responsible for ensuring the efficient and effective running of the clinic, managing a team of healthcare professionals, and contributing to the overall growth and success of...

Hive Health Pte Ltd is revolutionizing access to quality, affordable healthcare for millions of Filipinos. We need passionate, driven individuals to help us make it happen.About the Job DescriptionThis role involves optimizing our healthcare operations by reviewing, analyzing, and validating medical availments and claims. The ideal candidate will have at...