Medical Review Nurse

1 week ago

Pasig Central Post Office P, Philippines International SOS Full time ₱450,000 - ₱900,000 per year

Job Title: Medical Review Nurse

Location: Ortigas, Pasig

Set-up: Onsite

Shift: Monday-Friday, Dayshift

Overall Purpose of the job:

The Medical Review Nurse will be responsible for reviewing and processing incoming medical reports for beneficiaries. They will ascertain whether a case can be closed if care is complete or will issue an authorisation to a network provider when follow up care is required.

The Medical Review Nurse will communicate with beneficiaries, providers, and points of contact via email when needed. If additional intervention is required, the Medical Review Nurse will appropriately task other teams within the case.

Key Responsibilities:

Process medical reports as follows:

  • Review medical reports to check for accuracy and completeness, raising any quality issues identified as needed.
  • Close cases where no further care is required
  • Perform benefit reviews when further care is required, issuing authorisation letters or denials as appropriate
  • Reallocate cases to the relevant team for regional expertise as required
  • Email beneficiaries to inform them of non-urgent advice for follow up care in the future
  • Send updates to the client when contractually required.
  • Escalate complex cases to the Medical Review Nurse Team Leader or Senior Medical Review Nurse
  • Escalate any concerns/complaints to the Medical Review Nurse Team Leader
  • Ensure consent and confidentiality is maintained for all medical information

Miscellaneous:

  • Maintain accurate and confidential beneficiary case files in accordance with International SOS policies and procedures.
  • Ensure a high level of professionalism at all times
  • Work within a team to protect and promote the health and wellbeing of beneficiaries.
  • Be accessible and responsive to client and colleagues' questions and requests for information.
  • Attend internal and external meetings where appropriate and as requested.
  • Carry out any other reasonable duties as requested by the Medical Review Team Leader.

Required Qualifications

  • Active Philippines Registered Nurse License (valid for at least 12 months upon application)
  • Graduate of Bachelor of Science in Nursing
  • USA Registered Nurse License desirable but not essential

Preferred / Desirable Work Experience

  • At least 2 years of clinical experience
  • Broad nursing experience is preferred
  • Prior experience in utilization management, case management or reviewing of medical reporting is also desirable.

Required Languages/ Skills

  • Excellent written and oral English Language
  • Computer literate
ISOSHC

Job Type: Full-time

Work Location: In person

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