Clinical Utilization Review Specialist
1 month ago
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 and appropriateness of care
- Ensure compliance with regulatory requirements, including workers' compensation laws and URAC standards
- Collaborate with healthcare providers and other stakeholders to gather information and resolve issues
- Analyze data and identify trends to inform business decisions
- Bachelor's degree in nursing (BSN)
- Active unrestricted RN license that can be validated through the PRC website
- 1-2 years of relevant clinical experience in any medical/surgical department, orthopedic, medical/surgical ICU, coronary care unit (CCU), rehabilitation, or emergency department
- Written and verbal fluency in English
- Ability to work onsite in BGC and meet US operation hours
- Proficiency in all Microsoft Office products, including Project, Word, Excel, PowerPoint, Visio, and SharePoint
- Knowledge of workers' compensation laws and regulations, behavioral health, case management practice, URAC standards, ODG, utilization review, pharmaceuticals to treat pain, pain management process, drug rehabilitation, state workers compensation guidelines, periods of disability, and treatment needed
- Leadership/management/motivational skills as well as analytic and strong organizational skills
- Ability to work in a team environment and meet or exceed performance competencies
₱480,000 - ₱600,000 per annum
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Clinical Utilization Specialist
1 month ago
Taguig, National Capital Region, Philippines Gratitude Philippines Full timeGratitude 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...
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Clinical Utilization Specialist
1 month ago
Taguig, National Capital Region, Philippines Manpower Core Group Inc. Full timeManpower 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...
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Senior Quality Assurance Specialist
1 month ago
Taguig, National Capital Region, Philippines Gratitude Philippines Full timeJob DescriptionGratitude Philippines is seeking a highly skilled Senior Quality Assurance Specialist to join our team. This role will be responsible for ensuring the highest standards of quality in our clinical services.About the RoleWe are looking for a dedicated professional with strong clinical expertise and a passion for quality assurance. As a Senior...
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Clinical Coding Specialist
1 month ago
Taguig, National Capital Region, Philippines QUESS PHILIPPINES CORPORATION Full timeAbout the RoleWe are seeking a highly skilled Clinical Coding Specialist to join our team at Quess Philippines Corporation.Job DescriptionThis is a 4-month contract position with the possibility of extension depending on project requirements. The successful candidate will be required to work in a hybrid setup, with some remote training and occasional RTO...
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Clinical Laboratory Specialist
1 month ago
Taguig, National Capital Region, Philippines Wellnostics Inc. Full timeWe are seeking a highly skilled Clinical Laboratory Specialist to join our team at Wellnostics Inc. in the Philippines. This is an exciting opportunity for individuals who want to make a difference in the healthcare industry.About UsWellnostics Inc. is a leading provider of diagnostic services that empower individuals to take charge of their well-being. Our...
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Senior Clinical Claims Specialist
1 month ago
Taguig, National Capital Region, Philippines TASQ Staffing Solutions Full timeAbout TASQ Staffing SolutionsTASQ Staffing Solutions is a leading staffing agency that provides top talent to various industries. As a clinical claims specialist, you will be part of our esteemed team.Salary:$50,000 - $70,000 per year (dependent on experience)Job DescriptionWe are seeking an experienced Senior Clinical Claims Specialist to join our team at...
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Clinical Operations Director
1 month ago
Taguig, National Capital Region, Philippines Gratitude Philippines Full timeJob Title: Clinical Operations DirectorLocation: PhilippinesAbout Gratitude Philippines:We are a leading organization in the industry, and we are looking for a highly skilled and experienced Clinical Operations Director to join our team. As a Clinical Operations Director, you will play a key role in the success of our organization.Main...
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Clinical Telephonic Nurse Specialist
2 months 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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Taguig, National Capital Region, Philippines Tasq Staffing Solutions Full timeJob OverviewWe are seeking a highly skilled Clinical Nurse Specialist to join our client's team in a full-time capacity.
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Clinical Coding Specialist
2 weeks ago
Taguig, National Capital Region, Philippines Manpower Core Group Inc. Full timeJob DescriptionRole Summary:Clinical Coders play a vital role in the healthcare industry, ensuring that medical records are accurately coded and classified. We are seeking an experienced Clinical Coder to join our team in Manila, Philippines.Responsibilities:Review claims for errors and rejections, correcting them as needed to ensure accurate coding and...
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Clinical Nurse Practitioner
1 week ago
Taguig, National Capital Region, Philippines TASQ Staffing Solutions Full timeJob Title: Clinical Nurse Practitioner - Accidental Claims SpecialistAbout Us: TASQ Staffing Solutions is a leading provider of healthcare professionals, and we are currently seeking an experienced Clinical Nurse Practitioner to join our team.Salary Range: $80,000 - $120,000 per annum, depending on experience and qualifications.Job Description: As a Clinical...
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Medical Coding Specialist
1 month ago
Taguig, National Capital Region, Philippines Tasq Staffing Solutions Full timeJob Overview">We are seeking a skilled Medical Coding Specialist to join our team at Tasq Staffing Solutions. As a Medical Coding Specialist, you will play a vital role in ensuring accurate and efficient coding of patient data.About the Role">This is a fantastic opportunity for an experienced medical coder to work onsite at Taguig. The ideal candidate will...
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Clinical Claims Nurse
1 week ago
Taguig, National Capital Region, Philippines TASQ Staffing Solutions Full timeAt TASQ Staffing Solutions, we are seeking a skilled Clinical Claims Nurse to join our team as an Accidental Injury Specialist.Estimated Salary: $40,000 - $60,000 per yearThe ideal candidate will have a Bachelor's degree in nursing and be a PHRN certified professional with 1-2 years of experience in a similar role within the BPO/Shared Services industry....
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Clinical Healthcare Specialist
3 weeks ago
Taguig, National Capital Region, Philippines TASQ Staffing Solutions Full timeWe are seeking a skilled Clinical Healthcare Specialist to join our team at TASQ Staffing Solutions.The ideal candidate will have a strong background in claims experience within the BPO/shared services industry and possess excellent English communication skills.This is an exciting opportunity to work onsite with comprehensive training, followed by a hybrid...
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Digital EAM Solutions Specialist for Utilities
1 month ago
Taguig, National Capital Region, Philippines Neksjob Full timeNeksjob is seeking a skilled Digital EAM Solutions Specialist to join our team. This role requires expertise in Enterprise Asset Management (EAM) solutions, particularly in the utilities industry.About the JobWe are looking for an experienced professional with a strong background in SAP S/4HANA PM and EAM implementation. The successful candidate will have a...
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Utility Operations Specialist
4 weeks ago
Taguig, National Capital Region, Philippines Holistic Approach Systems Inc. Full timeJob OverviewThe Utility Worker plays a vital role in maintaining the smooth operation of facilities and equipment, ensuring a safe working environment for all.
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Taguig, National Capital Region, Philippines Gratitude Philippines Full timeGratitude Philippines is seeking a highly skilled Medical Education Specialist to join our team. This role is ideal for an experienced professional looking to take their career to the next level.We are offering a competitive salary of $80,000 - $100,000 per year, depending on experience. If you have a passion for education and case management, we encourage...
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Telephonic Nurse Specialist
1 month ago
Taguig, National Capital Region, Philippines Manpower Core Group Inc. Full timeAt Manpower Core Group Inc., we are seeking a highly skilled Telephonic Nurse Specialist to join our team.About the RoleThe Telephonic Nurse Specialist will play a crucial role in providing safe and effective telephone assessments, patient care instructions, and directions to the appropriate level of care. This position requires strong clinical expertise,...
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Triage Nurse Specialist
1 month ago
Taguig, National Capital Region, Philippines Gratitude Philippines Full timeGratitude Philippines is seeking a highly skilled and experienced Triage Nurse Specialist to join our team. As a key member of our healthcare staff, you will be responsible for providing exceptional telephone assessments and patient care instructions to injured employees.About the RoleThe successful candidate will have a Bachelor's degree in nursing (BSN)...
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Medical Necessity Case Manager
1 month ago
Taguig, National Capital Region, Philippines Gratitude Philippines Full timeAbout Gratitude PhilippinesWe are a leading provider of medical management services, dedicated to delivering high-quality solutions that meet the evolving needs of our clients.Job SummaryWe are seeking an experienced Medical Necessity Case Manager to join our team in the Philippines. This is a unique opportunity to work with a dynamic company and contribute...