Healthcare Professional – RN

2 weeks ago


Barcelona, Philippines beBeeNurse Full time ₱50,000 - ₱68,000
Job Opportunity

Nezda Technologies is currently seeking a Clinical Nurse Case Manager - USRN.

This position offers flexibility and autonomy in a remote work environment.

Key aspects of the role include conducting medical management review activities, ensuring member access to quality healthcare, and consulting with clinical reviewers to ensure high-quality care.

Qualifications
  • Active and Non-Active USRN License.
  • At least 1 year of experience in clinical or hospital settings.
Responsibilities
  1. Conduct UM pre-service, concurrent, retrospective, out-of-network, and appropriateness of treatment setting reviews.
  2. Review service requests for compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
  3. Utilize client-specific criteria sets, medical policy, and clinical guidelines for decision making.
  4. Responsible for conducting medical management review activities that require reviewing clinical information against client-specific criteria.
  5. Ensure member access to medically necessary, quality healthcare in a cost-effective setting according to the contract.
  6. Consult with clinical reviewers and/or U.S. licensed medical directors to ensure high-quality, cost-effective care throughout the medical management process.

This opportunity provides a direct employment arrangement with no bond requirements.



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