Healthcare Specialist with Utilization Review Expertise

About the Role:We are seeking a skilled Healthcare Utilization Specialist to join our dynamic team at UST. As a key member of our healthcare team, you will play a critical role in ensuring the highest quality patient care while promoting efficient resource utilization.We are looking for a registered nurse with current, unrestricted US licensure and at least...

We are looking for a seasoned professional to take on the role of Team Leader at Access Healthcare Services Manila, Inc. This individual will be responsible for overseeing the operations of our Pharmacy Utilization account and ensuring that our team delivers exceptional results.The ideal candidate will have a strong background in pharmacy utilization...

About This PositionWe seek a dedicated Clinical Appeals Coordinator to join our team at UST. As a key member, you will play a vital role in providing exceptional customer support, managing complex appeals and grievances, and ensuring high-quality outcomes.Your responsibilities will include investigating and processing appeals, reviewing services for medical...

Job Summary: We are seeking a highly skilled Team Leader to join our team at Access Healthcare Services Manila, Inc. As a Team Leader, you will be responsible for overseeing the operations of our Pharmacy Utilization account and ensuring that our team delivers exceptional results.Key Responsibilities:Manage a team of professionals handling pharmacy...

Job Description: We are seeking a highly skilled Team Leader to join our team at Access Healthcare Services Manila, Inc. As a Team Leader, you will be responsible for overseeing the operations of our Pharmacy Utilization account and ensuring that our team delivers exceptional results.Responsibilities:Lead a team of professionals handling pharmacy utilization...

Cobden & Carter International: A Leader in Patient-Centered CareWe are seeking a highly skilled Utilization Review Registered Nurse to join our team in delivering exceptional patient care. As a key member of our team, you will be responsible for conducting initial admission and continued stay reviews utilizing InterQual and MCG to identify and support the...

Job Description:Sourcing Specialists at Access Healthcare Services are responsible for ensuring the timely completion of assigned patient cases.Key responsibilities include performing advanced level work related to clinical denial and utilization management, managing medical denials by conducting comprehensive reviews of clinical documentation, handling...

Access Healthcare is looking for a highly skilled Team Leader to oversee operations for our Pharmacy Utilization account based in Taguig City. The ideal candidate must be a Licensed Pharmacist with extensive experience managing U.S. healthcare accounts, particularly in pharmacy utilization management, prior authorization, and compliance. This role requires...

At Access Healthcare Services Manila, Inc., we are seeking a highly skilled Team Leader to oversee operations for our Pharmacy Utilization account based in the Philippines. The ideal candidate must be a Licensed Pharmacist with extensive experience managing U.S. healthcare accounts, particularly in pharmacy utilization management, prior authorization, and...

Key Responsibilities:Perform advanced level work related to clinical denial and utilization managementManage medical denials by conducting comprehensive reviews of clinical documentationHandle audit/compliance responsibilities and other administrative duties as requiredResolve charge problems to ensure accurate and complete billingThis role requires a...

ObjectiveTo secure proper reimbursement for denied insurance claims by analyzing the root cause of denials and composing effective appeal letters.Main TasksReview activity summary, documentation, and correspondence to obtain notes related to the denial.Work on Medical Necessity and No Authorization denials, and Untimely filing only.Compose appeal letter if...

Job Summary:UST is seeking a qualified Medical Reviewer Nurse to join our team. As a key member of our healthcare team, you will play a critical role in ensuring the highest quality patient care while promoting efficient resource utilization.We are looking for a registered nurse with current, unrestricted US licensure and at least 3 years of direct, clinical...

At Access Healthcare Services Manila, Inc., we are committed to delivering high-quality healthcare services to our patients.We are currently seeking a skilled Registered Nurse to assume a key role in our team.Job Summary:Perform advanced level work related to clinical denial and utilization management.Manage medical denials by reviewing clinical...

Job Description:At UST, we are seeking a skilled Clinical Utilization Manager to join our team. As a key member of our healthcare team, you will play a critical role in ensuring the highest quality patient care while promoting efficient resource utilization.We are looking for a registered nurse with current, unrestricted US licensure and at least 3 years of...

About the RoleWe are seeking a skilled Clinical Authorization Specialist to join our team at Omega Healthcare Management Services Inc.This role is ideal for individuals with a passion for delivering exceptional patient care and a strong understanding of healthcare regulations.

Access Healthcare Services Manila, Inc. is a leading healthcare provider seeking a skilled Registered Nurse to assume a critical role in our team.The successful candidate will be responsible for managing medical denials by conducting comprehensive reviews of clinical documentation.Key Responsibilities:Handle audit and compliance responsibilities.Write...

Access Healthcare Services Manila, Inc. is a leading provider of healthcare solutions, seeking highly motivated and detail-oriented individuals to join our team as Prior Authorization Coordinators. This role is ideal for fresh graduates with a Medical Allied degree who possess excellent communication skills and are eager to build their careers in a BPO...

Quality Healthcare SpecialistTASQ is seeking a Quality Healthcare Specialist to fill a key role on their team.Key Responsibilities:Review and analyze medical records to ensure compliance with industry standards.Develop and implement effective strategies to improve clinical documentation practices.Collaborate with healthcare teams to resolve data...

About the Role:We are seeking a Clinical Operations Specialist to join our team at Access Healthcare Services.As a Clinical Operations Specialist, you will be responsible for managing medical denials, conducting comprehensive reviews of clinical documentation, and handling audit/compliance responsibilities.The ideal candidate will have a strong background in...

Job Duties and ResponsibilitiesPrioritize incoming authorization and referral requests according to queue urgency.Review patient's clinical and chart documentation related to the service submitted by the provider's office.Obtain and/or follow up on authorization and referral requests from the patient's payer/s through any of the following methods—depending...