Clinical Resource Specialist

1 day ago


Cabuyao, Calabarzon, Philippines beBeeUtilizationManagement Full time ₱45,000 - ₱65,000
Healthcare Utilization Management Specialist

We are seeking a skilled and experienced Healthcare Utilization Management Specialist to join our team.

Job Description:
  • This is an exciting opportunity to work as a clinical resource, reviewing inpatient and outpatient services for medical necessity and appropriateness.
Requirements:
  • Must have active PHRN and USRN Mainland License.
  • Preferably with 1 year Clinical bedside experience.
  • Background in Workers Compensation Utilization Management reviews (Prospective/Concurrent/Retrospective) for Inpatient/ Outpatient services according to URAC standards.
  • Background in Healthcare Utilization Management Provider Appeals reviews (Prospective/Concurrent/Retrospective) for Inpatient/ Outpatient services according to URAC standards.
  • Strong communication and teamwork skills.
Benefits:
  • Work From Home arrangement available.
  • Fixed weekends off.
  • Night Shift schedule.
  • Opportunity to work with a dynamic and growing organization.


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