Utilization Management USRN Analyst

2 days ago

Manila, National Capital Region, Philippines Go-Get Data Consultancy Full time ₱500,000 - ₱1,000,000 per year

JOB TITLE: Utilization Management US RN Sr Analyst

WORK SET UP: Full On-site in Uptown BGC, Taguig

WORK SHIFT: Depends with the client and project but they are looking for someone who can work on a shifting schedule

There is an attractive signing bonus of up to Php 100,000. (Terms and Conditions apply)

We're looking for candidates with the following skills and experience for this role. Do you fit the profile? If you do, we'd love to hear from you

Minimum Requirements:


• Bachelor of Science Nursing (BSN) degree or General Nursing & Midwifery (GNM) Diploma or Basic Bachelor of Science (BSC) in Nursing degree or Associate Nursing Degree or Nursing Diploma


• Holds a current and unrestricted US Registered Nurse license is required


• 3 months clinical experience (480 hours of working experience as a RN)


• must have at least one year of Utilization Management experience.


• Work experience as an active RN license and providing direct patient care


• Clinical setting includes inpatient hospital, outpatient hospital or community clinic


• No state license required


• Should be able to start by December 2025


• Ready to work full onsite in Taguig


• Open for those applicants who are currently in Philippines and already have the right to live and work in this country are eligible for this role


• Should not be a job hopper who only works for less than a year per company

Job Description


• Grievance & Appeals


• Creates complete appeal records for external appeal reviews, using standardized Independent Review Entity (IRE) forms and including all required documentation.


• Creates a detailed case summary in narrative format for each appeal.


• Submits cases as directed for each applicable geographic region.


• Presents verbal and written case summaries to client's Grievance Team and client Medical Directors.


• Completes assignments within client-designated turnaround times.

RECRUITMENT PROCESS:


• Screening with CV Reviewer


• Endorse for CV screening through Workday, along with the HRI toolkit, FCV and CV


• For reviewing with the client

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