Nurse Care Manager Position

1 day ago

Cavite City, Calabarzon, Philippines beBeeCare Full time ₱50,000 - ₱68,000
Job Opportunity

Clinical Nurse Case Managers play a vital role in ensuring member access to quality healthcare in a cost-effective setting. They are responsible for conducting medical management reviews, reviewing service requests, and utilizing client-specific criteria sets.

Key Responsibilities:
  • Conduct UM pre-service, concurrent, retrospective, out-of-network, and appropriateness of treatment setting reviews.
  • Review service requests for compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
  • Utilize client-specific criteria sets (e.g., Milliman or InterQual) and applicable clinical guidelines for decision-making.
  • Ensure members have access to high-quality care throughout the medical management process.
Requirements:
  • Active USRN License.
  • At least 1 Year Clinical or Hospital Experience.
Benefits:
  • Work-from-home opportunity.
  • Direct employment.
  • Partnership opportunities.

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