Medical Necessity Case Manager
1 month ago
We are a leading provider of medical management services, dedicated to delivering high-quality solutions that meet the evolving needs of our clients.
Job SummaryWe are seeking an experienced Medical Necessity Case Manager to join our team in the Philippines. This is a unique opportunity to work with a dynamic company and contribute to the success of our clients.
Key Responsibilities:- Treatment Authorization Review: Conduct thorough reviews of treatment authorization requests to ensure medical necessity and adherence to state guidelines.
- Clinical Decision Making: Make informed decisions regarding treatment approvals or denials, considering factors such as medical necessity, jurisdictional guidelines, and evidence-based practices.
- Nurse Collaboration: Work closely with PH Nurses to review treatment plans, identify potential issues, and develop strategies for optimal patient outcomes.
- Documentation and Reporting: Maintain accurate and comprehensive records of case management activities, including treatment plans, progress notes, and outcome assessments.
- Bachelor's degree in nursing (BSN)
- Active unrestricted RN license
- 1-2 years of relevant clinical experience in any medical/surgical department, Orthopedic, Medical/Surgical ICU, Coronary Care Unit (CCU), Rehabilitation, Emergency department
- Written and verbal fluency in English
- Ability to work onsite in BGC, Philippines, and within US operation hours
- Proficiency in Microsoft Office products, including Project, Word, Excel, PowerPoint, Visio, and SharePoint
- Knowledge of workers' compensation laws and regulations, behavioral health, case management practice, URAC standards, ODG, Utilization review, pharmaceuticals to treat pain, pain management process, drug rehabilitation, state workers compensation guidelines, periods of disability, and treatment needed
- Leadership/management/motivational skills, as well as analytic and strong organizational skills
We offer a competitive salary of PHP 800,000 per annum, commensurate with experience, plus additional benefits, including medical and dental insurance, retirement plan, and generous paid time off.
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