Clinical Nurse Associate

Be a Clinical Nurse Associate (US Registered Nurse) for our Pasig- Tiendesitas site. This role will focus on driving customer satisfaction by fielding inquiries, addressing pain points and maintaining extensive product knowledge.

As a Clinical Nurse Associate, you will serve as a vital link between complex clinical data and high-quality member care. Your expertise will span Case Management and Utilization Management. By applying sound clinical judgment and advocating for member health, you will empower patients to achieve better outcomes while ensuring healthcare services are medically appropriate and cost-effective.

Key Responsibilities

• Clinical Review & Decision Making: Perform comprehensive reviews of inpatient and outpatient services to determine medical necessity. This includes Concurrent Review (Telephonic Care Management) and evaluating medical claims and appeals.
• Member Advocacy: Act as a healthcare guide for members—providing education, support, and empowerment to improve their quality of life and encourage effective self-care.
• Guideline Application: Utilize industry-standard clinical resources and evidence-based guidelines, and internal medical policies—to ensure accurate benefit determination.
• Compliance & Standards: Adhere strictly to U.S. state and federal mandates, national/local coverage determinations, and specific regulatory requirements to ensure "First-Pass" clinical accuracy.
• Interdisciplinary Collaboration: Work seamlessly with a multidisciplinary team of healthcare professionals to coordinate care and escalate complex cases when necessary.

Required Qualifications

• Licensure: Must hold a valid and unrestricted USRN license.
• Clinical Experience: Minimum of 2 years of bedside hospital experience in the US is required to ensure strong clinical foundations.
• Technical Proficiency: Strong computer navigation skills and the ability to multitask across various clinical platforms and documentation systems.
• Core Competencies: Exceptional clinical judgment, deep understanding of care coordination, and the ability to interpret complex medical policies.

Preferred Qualifications

• Prior experience in a BPO environment focusing on Utilization Management (UM) or Case Management (CM).
• Familiarity with U.S. healthcare regulations and insurance workflows..

What's in it for YOU

Driven by our "Malasakit" culture, we make certain that our team members are well-cared for. Hence we are proving these employee benefits, which you'll be able to utilize once you join our team

• Day 1 HMO
• Meal & Transportation Allowance
• Rice Subsidy
• Clothing Allowance
• 24/7 Teleconsult
• Free Psychologist Consultation
• In-house & Online Pharmacy
• Scholarship Program
• Retirement Fund
• Free Meal & Medicine
• Loyalty Incentives
• Accidental & Life Insurance
• Free Shuttle Service

We're relentlessly committed- to our clients and each other. Every day, someone starts their journey with us. Taking the potential they have today, and turning it into skills for the future. Getting recognized for working hard, being a team player, and supporting others. Championing positive, lasting change in their teams and communities. That's just how we are. Here we care, and root for each other. You're included, just as you are, from day one. And with the right mindset, there's no end to how far we can go together.

We are highly driven by our "Malasakit" culture. In its very core, is all about an inclusive team that is focused on people. It all comes down to setting the bar for dignity, equality, and respect. It means that each one takes part in proactively shaping, cultivating, and building the company we want to work and live in. This is why genuine concern is so vital to us.