USRN Hiring Iloilo

1 week ago

PHLILOOne Fintech Place Iloilo Business Park Megaworld Blvd Mandurriao, Philippines Carelon Global Solutions Full time ₱30,000 - ₱60,000 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.

  • Assistant Manager for Contact Center

    1 week ago

    PHL-ILO-One Fintech Place, Iloilo Business Park, Megaworld Blvd, Mandurriao, Philippines Carelon Global Solutions Full time ₱60,000 - ₱100,000 per year

    Position Title:Assistant Manager for Contact Center - IloiloShift:Job Description:Responsible for serving as the operations point of contact in for day-to-day operations, including but not limited to,facilitating issue resolution, meeting goals and targetsPrimary duties may include, but are not limited to:Conducts Performance reviews and participates in...

  • Transcom Iloilo is Hiring No Experience Needed

    3 weeks ago

    Iloilo, Philippines JobsAvenuePH Full time

    Transcom Iloilo is Hiring – No Experience Needed Why Join Transcom Iloilo? Build your BPO career right here in Iloilo. No need to go to Bacolod, Cebu, or Manila — Transcom Iloilo offers a stable and exciting career opportunity in your own city. If you are from Iloilo City, Pavia, Oton, Leganes, or nearby towns, this is your chance to work closer to home...

  • Transcom Iloilo is Hiring No Experience Needed

    2 weeks ago

    Iloilo, Philippines JobsAvenuePH Full time

    Transcom Iloilo is Hiring – No Experience Needed Why Join Transcom Iloilo? Build your BPO career right here in Iloilo. No need to go to Bacolod, Cebu, or Manila — Transcom Iloilo offers a stable and exciting career opportunity in your own city. If you are from Iloilo City, Pavia, Oton, Leganes, or nearby towns, this is your chance to work closer to home...

  • Transcom Iloilo is Hiring No Experience Needed

    3 weeks ago

    Iloilo City, Philippines JobsAvenuePH Full time

    Transcom Iloilo is Hiring – No Experience Needed Why Join Transcom Iloilo? Build your BPO career right here in Iloilo. No need to go to Bacolod, Cebu, or Manila — Transcom Iloilo offers a stable and exciting career opportunity in your own city. If you are from Iloilo City, Pavia, Oton, Leganes, or nearby towns, this is your chance to work closer to home...

  • Get 20K bonus when you get hired to our Healthcare Team

    6 days ago

    Mandurriao, Iloilo, Philippines WNS Global Services, Inc. Full time

    WNS is looking for someone who communicate with customers in a professional manner & provide solution for specific requests as per process guidelines. Listen attentively to customer needs and demonstrate empathy while providing the customer support.Qualifications:• Must be a senior high school graduate• Must have 1 year Healthcare BPO experience•...

  • Customer Service Representative

    4 weeks ago

    Ilo-Ilo City, Philippines ETeam Full time

    Hiring for: Customer Service Representative - Healthcare Account Location: Iloilo City Interview Mode: Onsite or Virtual We are expanding our team and looking for passionate and experienced Customer Service Representatives for our Healthcare Account! Join us and be part of a dynamic and supportive environment. Job Qualifications: - At least two years of...

  • Service Technician

    1 week ago

    Mandurriao, Iloilo, Philippines Paintworks Enterprises Inc. Full time

    We're Hiring: Service TechnicianLocation: Diversion Rd, Mandurriao, Iloilo City, 5000 IloiloCompany: Auto Studio Philippines CorporationQualifications:Car Technician for atleast 1 yearFresh Graduates are very much welcome to apply (Graduate from an Automotive Related Course)Excellent Communication SkillsMust have Driver's License (1,2)Excited to TravelWhy...

  • Sales Consultant

    1 week ago

    Mandurriao, Iloilo, Philippines Paintworks Enterprises Inc. Full time

    We're Hiring: Sales ConsultantLocation: Diversion Rd, Mandurriao, Iloilo City, 5000 IloiloCompany: Auto Studio PhilippinesAre you passionate about sales and ready for an adrenaline rush? Join our dynamic team as a Sales Consultant and be part of a fast-paced, rewarding environment that values drive, excellence, and enthusiasm.Qualifications:• Must meet or...

  • USRN Hiring Manila

    2 days ago

    PHL-Taguig City-Alliance Global Tower, th Ave, Corner th St, Uptown Bonifacio, Philippines Carelon Global Solutions Full time

    Position Title:USRN Hiring ManilaShift: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,...

  • Delivery Helper-Iloilo

    2 weeks ago

    Iloilo, Philippines Commonwealth Foods, Inc. Full time

    Duties and Responsibilities: Helper works with salesman and driver to deliver products to customers and clients. Helpers are responsible for all tasks such as loading and unloading the truck. Responsible to assure that all item for delivery is safely loaded and secured. Compiling accurate delivery records and reports. Responsible to ensure good customer...