Clinical Utilization Specialist
4 weeks ago
Gratitude Philippines is seeking a highly skilled Utilization Reviewer to join our team.
Key Responsibilities:- Conduct thorough reviews of medical records to ensure compliance with workers' compensation laws and regulations.
- Utilize strong analytical and organizational skills to identify areas for improvement in healthcare utilization.
- Collaborate with healthcare providers to develop and implement effective case management plans.
- Stay up-to-date with industry standards, including URAC standards, ODG, and workers' compensation guidelines.
- Provide expert guidance on pain management and treatment options.
- Bachelor's degree in nursing (BSN) and active unrestricted RN license.
- 1-2 years of relevant clinical experience in medical/surgical departments, ICU, or emergency departments.
- Excellent written and verbal communication skills in English.
- Ability to work onsite in BGC and meet US operation hours.
- Proficiency in Microsoft Office products, including Project, Word, Excel, PowerPoint, Visio, and SharePoint.
- Leadership and management skills, as well as strong organizational and analytical skills.
We offer a dynamic and supportive work environment, with opportunities for growth and development. If you are a motivated and detail-oriented professional with a passion for healthcare, we encourage you to apply.
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Clinical Utilization Specialist
4 weeks ago
Taguig, National Capital Region, Philippines Gratitude Philippines Full timeJob Title: Clinical Utilization SpecialistGratitude Philippines is seeking a highly skilled Clinical Utilization Specialist to join our team. As a key member of our healthcare team, you will play a vital role in ensuring the highest quality of care for our patients.Key Responsibilities:Conduct thorough reviews of patient cases to ensure medical necessity and...
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Clinical Utilization Review Specialist
4 weeks ago
Taguig, National Capital Region, Philippines Gratitude Philippines Full timeJob Title: Clinical Utilization Review SpecialistGratitude Philippines is seeking a highly skilled Clinical Utilization Review Specialist to join our team. As a key member of our healthcare team, you will play a critical role in ensuring that our clients receive the most appropriate and cost-effective care.Key Responsibilities:Review treatment authorization...
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Clinical Utilization Review Specialist
2 weeks ago
Taguig, National Capital Region, Philippines Gratitude Philippines Full timeJob Title: Clinical Utilization Review SpecialistAbout the Role:Gratitude Philippines is seeking a highly skilled Clinical Utilization Review Specialist to join our team. As a key member of our Utilization Review team, you will be responsible for reviewing treatment authorization requests based on state guidelines and medical necessity.Key...
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Clinical Utilization Specialist
2 hours ago
Taguig, National Capital Region, Philippines Gratitude Philippines Full timeOverviewGratitude Philippines is a reputable healthcare organization seeking a skilled Clinical Utilization Specialist to join our team. This role plays a crucial part in ensuring the efficient use of medical resources and promoting high-quality patient care.
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Clinical Utilization Specialist
4 weeks ago
Taguig, National Capital Region, Philippines Gratitude Philippines Full timeJob Title: Utilization ReviewerGratitude Philippines is seeking a highly skilled Utilization Reviewer to join our team. As a Utilization Reviewer, you will play a critical role in ensuring that our healthcare services are delivered efficiently and effectively.Key Responsibilities:Conduct thorough reviews of medical records to ensure that healthcare services...
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Clinical Utilization Specialist
2 weeks ago
Taguig, National Capital Region, Philippines Gratitude Philippines Full timeJob Title: Utilization ReviewerJob Summary: We are seeking a highly skilled Utilization Reviewer to join our team at Gratitude Philippines. As a Utilization Reviewer, you will be responsible for reviewing medical records and ensuring that patients receive the necessary treatments and care. Our ideal candidate will have a Bachelor's degree in nursing, 1-2...
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Clinical Utilization Review Specialist
4 weeks ago
Taguig, National Capital Region, Philippines Gratitude Philippines Full timeJob Title: Utilization ReviewerGratitude Philippines is seeking a skilled Utilization Reviewer to join our team. As a Utilization Reviewer, you will play a critical role in ensuring that patients receive appropriate and necessary medical care while minimizing costs.Key Responsibilities:Review treatment authorization requests based on state guidelines and...
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Clinical Appeals Specialist
2 weeks ago
Taguig, National Capital Region, Philippines Gratitude Philippines Full timeRole Summary: We are seeking a skilled RN Clinical Specialist to join our team at Gratitude Philippines. In this role, you will be responsible for handling clinical appeals and denials for healthcare insurance claims.Key Responsibilities:Review and evaluate clinical appeals and denials for healthcare insurance claimsUtilize clinical expertise to make...
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Clinical Appeals Specialist
4 weeks ago
Taguig, National Capital Region, Philippines Gratitude Philippines Full timeClinical Opportunities at Gratitude Philippines**Job Summary**We are seeking a skilled Clinical Appeals Specialist to join our team. The ideal candidate will have a strong background in utilization management review or clinical appeals and denials handling for healthcare insurance/UMR.**Key Responsibilities**- Conduct thorough reviews of medical claims to...
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Clinical Appeals Specialist
4 weeks ago
Taguig, National Capital Region, Philippines Gratitude Philippines Full timeJob Title: Clinical Appeals SpecialistWe are seeking a highly skilled Clinical Appeals Specialist to join our team at Gratitude Philippines.Key Responsibilities:Review and analyze medical claims to ensure accurate processing and reimbursement.Communicate with healthcare providers and patients to resolve billing discrepancies.Develop and implement strategies...
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Clinical Support Specialist
4 weeks ago
Taguig, National Capital Region, Philippines MetaHealth Full timeJob SummaryWe are seeking a highly skilled Clinical Support Specialist to join our team at MetaHealth. As a key member of our healthcare team, you will play a vital role in ensuring the highest level of patient care and satisfaction.ResponsibilitiesProvide top-notch support to clients, ensuring their needs are met and exceeded.Utilize your analytical skills...
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Healthcare Professional for Clinical Support
3 weeks ago
Taguig, National Capital Region, Philippines MetaHealth Full timeJob SummaryMetaHealth is seeking a skilled Clinical Support Specialist to join our team. As a Clinical Support Specialist, you will be responsible for providing top-notch support to our clients. Your analytical skills will be utilized to troubleshoot and resolve issues, ensuring a positive impact on client satisfaction.ResponsibilitiesProvide clinical...
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Advanced Clinical Nurse Specialist
2 hours ago
Taguig, National Capital Region, Philippines Gratitude Philippines Full timeJob SummaryWe are seeking an experienced Advanced Clinical Nurse Specialist to join our team at Gratitude Philippines. In this role, you will utilize your expertise in utilization management review and clinical appeals and denials handling for healthcare insurance/ UMRS.About the RoleThis is a full-time position that requires flexible shifts, with a...
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Clinical Care Specialist
3 weeks ago
Taguig, National Capital Region, Philippines Megaworld Corporation Full timeWe are seeking a skilled Clinical Care Specialist to join our team at Megaworld Corporation. This is a Full-time position that requires a Registered Nurse with a strong background in patient care and clinical skills.The ideal candidate will have at least 1 year of experience in nursing and be proficient in MS Office. The following skills are...
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Clinical Coding Specialist
2 days ago
Taguig, National Capital Region, Philippines TASQ Staffing Solutions Full timeJob Title: Clinical Coding SpecialistAbout the Role:We are seeking a skilled Clinical Coding Specialist to join our team at TASQ Staffing Solutions.Key Responsibilities:The successful candidate will be responsible for performing accurate and timely coding of patient records, ensuring compliance with industry standards and regulations.Requirements:To be...
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Clinical Excellence Specialist
2 weeks ago
Taguig, National Capital Region, Philippines Gratitude Philippines Full timeJob Title: Clinical Excellence SpecialistJob Summary:We are seeking a Clinical Excellence Specialist to join our team at Gratitude Philippines. The successful candidate will be responsible for carrying out quality assurance oversight activities, conducting regular reviews of managed care internal and external claim files, and analyzing quality assurance...
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Clinical Nurse Specialist
2 hours ago
Taguig, National Capital Region, Philippines TASQ Staffing Solutions Full timeJob Title: Clinical Nurse Specialist - Accidental ClaimsAbout the Role: We are seeking a highly skilled Clinical Nurse Specialist to join our team at TASQ Staffing Solutions. As a key member of our staff, you will be responsible for handling accidental claims with exceptional attention to detail and organizational skills.Job Responsibilities: Your primary...
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Clinical Review Nurse
4 weeks ago
Taguig, National Capital Region, Philippines Manpower Core Group Inc. Full timeJob Title: Clinical Review NurseAt Manpower Core Group Inc., we are seeking a highly skilled Clinical Review Nurse to join our team. As a Clinical Review Nurse, you will play a critical role in assessing the medical appropriateness of proposed treatments and medications for our injured employees.Key Responsibilities:Review treatment authorization requests...
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Clinical Telephonic Nurse Specialist
2 hours ago
Taguig, National Capital Region, Philippines Manpower Core Group Inc. Full timeOverviewThe Manpower Core Group Inc. seeks a skilled Clinical Telephonic Nurse Specialist to provide exceptional patient care and support via telephone assessments, health advice, and referrals.Key Responsibilities:Performing intake of phone calls from injured employees to provide timely and effective assistance.Conducting telephonic health assessments,...
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Medical Coding Specialist
2 hours ago
Taguig, National Capital Region, Philippines Tasq Staffing Solutions Full timeTasq Staffing Solutions is hiring a Inpatient Medical Coder to join our team. This role is perfect for individuals with experience in clinical, BPO, or CPO set-ups who are passionate about medical coding and have excellent communication skills.The ideal candidate will possess a Bachelor's degree in Nursing or a related field and be certified as a Certified...