Medical Necessity Case Manager

7 days ago


Taguig, National Capital Region, Philippines Gratitude Philippines Full time
About Gratitude Philippines

We are a leading provider of medical management services, dedicated to delivering high-quality solutions that meet the evolving needs of our clients.

Job Summary

We 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.
Requirements:
  • 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
Preferred Qualifications:
  • 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
Compensation and Benefits:

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.


  • Medical Case Manager

    3 weeks ago


    Taguig, National Capital Region, Philippines Gratitude Philippines Full time

    Job Title: Medical Case ManagerLocation: PhilippinesEstimated Salary: 450,000 - 550,000 PHP per annumAbout the RoleWe are seeking a highly skilled and motivated Medical Case Manager to join our team at Gratitude Philippines. As a Medical Case Manager, you will be responsible for reviewing treatment authorization requests, conducting clinical assessments, and...


  • Taguig, National Capital Region, Philippines Manpower Core Group Inc. Full time

    Manpower Core Group Inc. is seeking a skilled Clinical Utilization Specialist - Medical Case Manager to join our team in BGC. This role plays a vital part in ensuring that employees receive the necessary medical care and support to return to work.About the Role:This position involves conducting thorough reviews of treatment authorization requests based on...


  • Taguig, National Capital Region, Philippines Gratitude Philippines Full time

    Job SummaryWe are seeking a skilled Nurse Case Manager to join our team at Gratitude Philippines. The successful candidate will be responsible for coordinating medical care and return-to-work plans for injured workers.Duties and ResponsibilitiesReview workers compensation claims and create return-to-work plans in collaboration with medical providers, injured...

  • Medical Case Manager

    3 weeks ago


    Taguig, National Capital Region, Philippines Gratitude Philippines Full time

    Job DescriptionWe are seeking a skilled Medical Case Manager to join our team at Gratitude Philippines. In this role, you will play a critical part in helping injured workers return to work by providing expert clinical guidance and support.


  • Taguig, National Capital Region, Philippines Gratitude Philippines Full time

    Gratitude Philippines is seeking a highly skilled Medical Education Specialist to join our team. This role is ideal for an experienced professional looking to take their career to the next level.We are offering a competitive salary of $80,000 - $100,000 per year, depending on experience. If you have a passion for education and case management, we encourage...


  • Taguig, National Capital Region, Philippines Gratitude Philippines Full time

    Job Title: Clinical Utilization Review SpecialistAbout the Role:Gratitude Philippines is seeking a highly skilled Clinical Utilization Review Specialist to join our team. As a key member of our Utilization Review team, you will be responsible for reviewing treatment authorization requests based on state guidelines and medical necessity.Key...


  • Taguig, National Capital Region, Philippines Gratitude Philippines Full time

    At Gratitude Philippines, we are committed to providing exceptional care to our clients. We are seeking a highly skilled Clinical Nurse Case Manager to join our team.Job SummaryWe are looking for a seasoned nurse with experience in case management to coordinate the individual's treatment program while maximizing quality and cost-effectiveness of care. As a...


  • Taguig, National Capital Region, Philippines ACCPRO International Full time

    Job Title:Medical Coding SpecialistAbout the Role:We are seeking a highly skilled Medical Coding Specialist to join our team at ACCPRO International. As a Medical Coding Specialist, you will be responsible for accurately assigning codes for diagnoses and procedures in patient medical records.Responsibilities:Review inpatient medical records and assign...


  • Taguig, National Capital Region, Philippines Gratitude Philippines Full time

    We are seeking a highly skilled Clinical Utilization Review Specialist to join our team at Gratitude Philippines. This role is responsible for conducting thorough reviews of medical records to ensure compliance with regulatory requirements and company standards.Key Responsibilities:Conduct clinical reviews of medical records to determine medical necessity...


  • Taguig, National Capital Region, Philippines NewAnt Medical Corporation Full time

    We are seeking a highly skilled Medical Engagement Strategist to join our team at NewAnt Medical Corporation.This is a unique opportunity to develop and execute strategies that foster collaboration with key opinion leaders in the industry, drive business growth, and enhance our brand presence.The successful candidate will have a strong understanding of the...

  • Clinical Review Nurse

    1 month ago


    Taguig, National Capital Region, Philippines Manpower Core Group Inc. Full time

    Job Title: BPO Utilization ReviewerSummary:The Clinical Review Nurse position is responsible for assessing the medical appropriateness of proposed treatments and medications for our injured employees. This role partners with the Client Claims Adjuster team to expedite medically necessary treatment for each claim, while maintaining a solid understanding of...


  • Taguig, National Capital Region, Philippines Gratitude Philippines Full time

    We are seeking a seasoned Medical Education Consultant to join our team at Gratitude Philippines. This role is perfect for an individual with a strong background in nursing education and experience in developing training programs.The successful candidate will have a proven track record of creating comprehensive education programs that meet the needs of...


  • Taguig, National Capital Region, Philippines Gratitude Philippines Full time

    Job OverviewGratitude Philippines is seeking a Medical Education Specialist to join our team. As a Medical Education Specialist, you will be responsible for developing and implementing comprehensive education programs to meet the orientation and ongoing competency needs of our medical staff.Key ResponsibilitiesResearch and develop training strategies,...


  • Taguig, National Capital Region, Philippines RecruiterPH Full time

    Role SummaryWe are seeking a skilled Disability Case Manager to join our team at RecruiterPH. In this role, you will be responsible for adjudicating disability claims and working closely with insured employees, clients, lawyers, and healthcare practitioners to provide timely and effective case management services.About the RoleThis is a challenging and...


  • Taguig, National Capital Region, Philippines RecruiterPH Full time

    Role OverviewWe are seeking a skilled Disability Management Professional to join our team at RecruiterPH. As a key member of our team, you will be responsible for managing disability cases and providing exceptional customer service to our clients.Key ResponsibilitiesConduct thorough assessments of employees' medical conditions to determine their eligibility...


  • Taguig, National Capital Region, Philippines RecruiterPH Full time

    Role Overview: We are looking for a skilled Disability Case Manager to join our team at RecruiterPH. As a Disability Case Manager, you will be responsible for adjudicating disability claims for eligibility of short and long-term benefits. This includes reviewing and analyzing contractual, medical, functional, and occupational information. Key...


  • Taguig, National Capital Region, Philippines NewAnt Medical Corporation Full time

    NewAnt Medical Corporation seeks a skilled KOL Manager to join our team. As a key member of our organization, you will be responsible for developing and executing strategies to engage and manage relationships with key opinion leaders in the industry.Key Responsibilities:KOL Identification and Engagement:Identify and map key opinion leaders within relevant...


  • Taguig, National Capital Region, Philippines RecruiterPH Full time

    Job RequirementsWe are seeking a skilled Medical Coding Specialist to join our team at RecruiterPH. The ideal candidate will have 1-3 years of experience in medical record coding, specifically in acute care settings.Key ResponsibilitiesPerform medical record coding with a focus on accuracy and attention to detail.Develop and maintain a strong understanding...


  • Taguig, National Capital Region, Philippines Wellnostics Inc. Full time

    Wellnostics Inc. is seeking a skilled Medical Care Specialist to join our team of healthcare professionals. With a focus on delivering exceptional patient care, this role offers a dynamic and collaborative work environment.About the Role:Diagnose and treat common illnesses and injuries, as well as manage chronic conditions.Work in a fast-paced environment...


  • Taguig, National Capital Region, Philippines RecruiterPH Full time

    Job Title: Medical Coding SpecialistWe are seeking a skilled Medical Coding Specialist to join our team at RecruiterPH. In this role, you will be responsible for coding medical records accurately and efficiently.Required Skills and Qualifications:A minimum of 1-3 years' experience in medical record coding in an acute care setting.Bachelor's degree in Health...