Medical Review Nurse

Position SummaryThe Utilization Review Nurse is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services across inpatient and outpatient settings. This role ensures that care aligns with clinical guidelines, payer requirements, and organizational policies — with a strong emphasis on proficiency in MCG...

I. Duties and Responsibilities:Delivers nursing care to clients within assigned areas, cognizant of the following key areas of responsibility:Identifies and analyzes the nursing needs of clientsProvides sound decision making in the care of client considering their beliefs and values.Performs age-specific safety measures in all aspects of clients...

Job Summary:The Occupational Health Nurse (OHNAP Nurse) is responsible for promoting and maintaining the health and well-being of employees by providing medical care, implementing health programs, and ensuring compliance with occupational health and safety standards. The role involves coordinating with HR and Safety departments in managing health records,...

Overview Visaya Knowledge Process Outsourcing Corporation is a proudly Filipino organization recognized globally for service excellence, innovation, and a culture of malasakit. We are committed to building long-term partnerships through quality, reliability, and a people-first approach. Role Overview We are seeking a skilled Utilization Management/Review...

Overview Visaya Knowledge Process Outsourcing Corporation is a proudly Filipino organization recognized globally for service excellence, innovation, and a culture of malasakit. We are committed to building long-term partnerships through quality, reliability, and a people-first approach. Role: Utilization Management / Review Nurse We are seeking a skilled...

Job SummaryThe Part-Time OSH Nurse is responsible for promoting and maintaining the health, safety, and well-being of employees in compliance with occupational safety and health standards. The nurse will support workplace health initiatives, administer first aid and emergency care, and assist in the implementation of company safety and wellness programs.Key...

Join Our Team as a Company NurseWhat you'll do:Provide first aid & medical supportPromote health and wellness at workBe a trusted advocate for employee well-beingWhat we're looking for:Registered Nurse with a valid PRC licenseExcellent communication & care skillsExperience in occupational health is a plusInterested applicants may send their updated resume to...

The PH Registered Nurse (PHRN) collaborates with healthcare providers and members to promote quality outcomes, optimize member benefits, and ensure the effective use of healthcare resources. This role ensures that care provided is medically appropriate, high-quality, and cost-effective by reviewing medical necessity for inpatient admissions, outpatient...

Duties and Responsibilities:A. Records ManagementMaintain and update patient medical records and hemodialysis treatment logs.Ensure completeness, accuracy, and confidentiality of all patient information.File and retrieve patient charts and records efficiently.Encode and track dialysis treatment sessions and laboratory results in the hospital system.B. ICD-10...

RESPONSIBILITIES:Review and evaluation: Review patient charts, clinical information, and documentation to assess the medical necessity and appropriateness of healthcare services.Criteria application: Apply clinical criteria (such as InterQual, MCG) and payer-specific guidelines to make determinations.Data analysis: Analyze clinical and financial data to...