USRN Hiring Iloilo

8 hours ago

Iloilo City, Western Visayas, Philippines Elevance Health Full time ₱300,000 - ₱600,000 per year

Position Title:

USRN Hiring Iloilo

Shift:

Job Description:

Responsible for collaborating with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources.

  • Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and clinical guidelines, accurately interpreting benefits, and managed care products, and steering members to appropriate providers, programs or community resources.
  • Works with medical directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied. Primary duties may include, but are not limited to:
  • Conducts pre-certification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
  • Ensures member access to medically necessary, quality healthcare in a cost effective setting according to contract.
  • Consults with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process.
  • Collaborates with providers to assess member's needs for early identification of and proactive planning for discharge planning. Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications. Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.
  • Requires a BSN, current active unrestricted RN license to practice as a health professional in applicable state(s) of the United States, and 1 year of acute care clinical experience or case management, utilization management or managed care experience, which would provide an equivalent background.
  • Healthcare related certification and/or Master's degree a plus. Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

  • 2025 - Stark Asia -NCLEX Academy Hiring

    2 days ago

    Iloilo City, Western Visayas, Philippines Elevance Health Full time ₱1,500,000 - ₱3,000,000 per year

    Position Title:2025 - Stark Asia -NCLEX Academy HiringShift:Job Description:Responsible for serving in an interim basis as a nurse trainee in the USRN Clinical Academy while obtaining NCLEX certification and USRN license prior to being deployed to a USRN function.Primary duties may include, but are not limited to:Attend review and USRN Academy Program for...

  • 2025 - Cobden & Carter -NCLEX Academy Hiring

    2 days ago

    Iloilo City, Western Visayas, Philippines Elevance Health Full time $40,000 - $60,000 per year

    Position Title:2025 - Cobden & Carter -NCLEX Academy HiringShift:Job Description:Responsible for serving in an interim basis as a nurse trainee in the USRN Clinical Academy while obtaining NCLEX certification and USRN license prior to being deployed to a USRN function.Primary duties may include, but are not limited to:Attend review and USRN Academy Program...

  • Warehouseman (Iloilo)

    1 week ago

    Iloilo City, Western Visayas, Philippines D'Emploi Human Resource Management Services Full time ₱150,000 - ₱250,000 per year

    URGENT HIRING: WAREHOUSEMANLocation: IloiloDUTIES AND RESPONSIBILITIESReceive, inspect, and properly store incoming construction materials and supplies.Prepare and issue materials to project sites as requested.Maintain accurate inventory records through manual logs or warehouse systems.Ensure proper labeling, organization, and safekeeping of materials and...

  • sales specialist-iloilo

    2 weeks ago

    Iloilo City, Western Visayas, Philippines JBW FloorCenter, Inc. Full time ₱150,000 - ₱250,000 per year

    NOTE: WE OFFERHigh performers are rewarded with our unlimited incentive scheme.Direct Hiring\Probationary StatusGood Salary PackageMandatory BenefitFree UniformRole and Responsibilities· Assisting walk-in clients, promoting and explaining the products· Developing sales strategies and setting up goals.· Generating leads and reaching out to prospects, and...

  • Recruiter / Admin

    2 days ago

    Iloilo City, Western Visayas, Philippines Caring One Iloilo Inc Full time ₱300,000 - ₱450,000 per year

    Job Purpose:The Recruiter / Admin will handle full-cycle recruitment and general administrative functions to support Caring-One Iloilo's operations. This includes sourcing and hiring qualified candidates, maintaining compliance with government requirements, managing business renewals, and coordinating with various agencies (DOLE, SEC, SSS, PhilHealth,...

  • Recruiter / Admin

    2 days ago

    Iloilo City, Western Visayas, Philippines Caring-One Iloilo Call Center Services Full time ₱250,000 - ₱400,000 per year

    Job Purpose:The Recruiter / Admin will handle full-cycle recruitment and general administrative functions to support Caring-One Iloilo's operations. This includes sourcing and hiring qualified candidates, maintaining compliance with government requirements, managing business renewals, and coordinating with various agencies (DOLE, SEC, SSS, PhilHealth,...

  • Boost Your Career US Telco Voice Account | Iloilo | Up to PHP 36,700

    1 week ago

    Iloilo City, Western Visayas, Philippines TTEC Full time ₱200,000 - ₱400,000 per year

    Your potential has a place here with TTEC's award-winning employment experience. As a Customer Service Representative working onsite in Iloilo you'll be a part of bringing humanity to business. #experienceTTECOur employees have spoken. Our purpose, team, and company culture are amazing and our Great Place to Work certification in Philippines says it allWe're...

  • Call Center

    1 week ago

    Iloilo City, Western Visayas, Philippines Nezda Technologies, Inc. Full time ₱20,000 - ₱30,000 per year

    Hiring for Customer Service Representative Virtual Hiring Process OnlyLocation: Jaro, Iloilo CityQualifications & Salary:0-6 mos experience (any account)College GraduateGood to Excellent Communication SkillsAmenable to work onsite20,000 package7 mos - 2 years BPO Heathcare Exp RequiredHS GraduateGood to Excellent Communication SkillsAmenable to work...

  • CSR - Teller, Iloilo - Pavia Branch

    1 week ago

    Iloilo City, Western Visayas, Philippines Metrobank Full time ₱200,000 - ₱250,000 per year

    Be #InGoodHands with MetrobankHere at Metrobank, we don't simply hire employees-we hone future leaders. We provide opportunities that enhance your skills and unlock your talents, helping you evolve into a well-rounded individual. We supply you with all the pieces you need to do your best work, unleashing your full potential to help you secure your future and...

  • Key Account Officer

    2 days ago

    Iloilo City, Western Visayas, Philippines AvantePH Staffing and Consultancy Inc. Full time ₱400,000 - ₱600,000 per year

    We are hiring a Key Account Officer to manage and grow strategic customer accounts in Iloilo, focusing on retail chains, distributors, or corporate clients in the FMCG or non-food industry. This role is responsible for achieving sales targets, maintaining strong client relationships, and ensuring the effective execution of trade promotions and...