Nurse Care Coordinator

2 weeks ago

Imus, Calabarzon, Philippines beBeeClinical Full time ₱50,000 - ₱68,000
About the Role

This role focuses on conducting medical management reviews, ensuring access to quality healthcare in a cost-effective setting.

Key responsibilities include:

  • Conducting pre-service, concurrent, retrospective, out-of-network, and appropriateness of treatment setting reviews to ensure high-quality care.
  • Reviewing service requests for compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
  • Utilizing client-specific criteria sets, medical policy, and clinical guidelines for decision making to deliver medically necessary care.
  • Evaluating and managing patient care to ensure effective use of healthcare resources while maintaining quality standards.
  • Consulting with clinical reviewers and/or U.S. licensed medical directors as needed to provide informed decision support.

To excel in this position, candidates should possess an active and non-active USRN license, at least 1 year of clinical or hospital experience, and a USRN with RN license.

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