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Clinical Review Specialist

1 week ago

Taguig, National Capital Region, Philippines ManpowerGroup Full time

Job Summary

The Clinical Review Specialist position is responsible for assessing the medical appropriateness of proposed treatments and medications for injured employees. This role requires a strong understanding of client mission, vision, and values.

Key Responsibilities:

  1. Review treatment authorization requests based on state guidelines and medical necessity.
  2. Work with claims adjusters to ensure denial decisions do not adversely affect claim outcomes.
  3. Perform utilization review activities prospectively, concurrently, or retrospectively in accordance with jurisdictional and evidence-based guidelines.
  4. Determine whether all aspects of patient care are medically necessary and appropriately delivered.

Requirements

  • Bachelor's degree in nursing (BSN)
  • Active unrestricted RN license
  • 1-2 years of relevant clinical experience
  • Written and verbal fluency in English