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Nurse Reviewer II Position

3 weeks ago

Manila, National Capital Region, Philippines Crawford Group Full time
Overview

Crawford Group offers an exciting opportunity for a highly skilled Clinical Program Nurse II to join our dynamic team. This role involves reviewing medical information to determine if requested treatment is medically necessary and appropriate according to the given standards.

Key Responsibilities:
  • Review and Analysis
    • Analyzes medical information to determine if requested treatment is medically necessary and appropriate.
    • Collaborates with peer physicians to facilitate case resolution.
    • Documents pertinent information to support utilization management determinations and case resolutions.
  • Business Operations Support
    • Plays a critical role in business operations by providing timely and accurate reviews.
    • Communicates effectively with stakeholders to ensure seamless collaboration.
    • Refers complex cases to immediate superiors for direction.
Qualifications:
  • Bachelor's degree in Nursing.
  • Active Philippine RN license.
  • Minimum one year diverse clinical experience or prior experience in medical bill review or claim/case review.
  • Excellent analytical and communication skills.
  • Ability to work independently and as part of a team.
  • High level of professionalism and confidentiality.
  • Continuing education requirements mandated by the Professional Regulation Commission.
  • Courses as outlined by Crawford Educational Services.