Senior Clinical Healthcare Coordinator

7 days ago


Tanauan, Calabarzon, Philippines beBeeCase Full time ₱50,000 - ₱68,000
Job Overview

Clinical Nurse Case Managers are responsible for managing patient care and ensuring that members receive medically necessary, quality healthcare in a cost-effective setting.

Responsibilities
  • Conduct Utilization Management (UM) reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
  • Review service requests to validate clinical information against client-specific criteria sets and applicable client-specific medical policy.
  • Collaborate with clinical reviewers and/or U.S. licensed medical directors to ensure medically appropriate, high-quality, cost-effective care throughout the medical management process.
  • Perform medical management review activities that require the review of clinical information against client-specific criteria.


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