Clinical Program Nurse II

3 days ago

Iloilo City, Western Visayas, Philippines Crawford & Company Full time ₱900,000 - ₱1,200,000 per year

Job Description
Responsible for reviewing medical information to determine if requested treatment is medically necessary and appropriate according to the given standards.

Responsibilities

  • Evaluation of Medical Information

  • Analyzes medical information and applies established criterion to facilitate the utilization review process.

  • Collaborates objectively with peer physicians to facilitate case resolution.
  • Utilizes appropriate resources to perform utilization review process.
  • Documents pertinent information in internal and external communications to support utilization management determinations and case resolutions.
  • Adheres to the given standard operating procedures (SOP) and turnaround time to complete the review process.

  • Demonstrates knowledge and understanding of Broadspire medical department policies and procedures and ability to communicate same with internal/ external customers as necessary.

  • Business Process Support

  • Plans and organizes individual caseload to meet requirements.

  • Communicates effectively with persons involved in the review process as needed.
  • Refers matters beyond limits of authority and expertise to immediate superior for direction.
  • Upholds the Crawford Code of Conduct by protecting the confidentiality of information.
  • Performs other related tasks as required or needed.
  • Demonstrates knowledge and understanding of Broadspire medical department policies and procedures and ability to communicate same with internal/ external customers as necessary.

Qualifications

  • Bachelor's degree in Nursing.
  • Must have an active and in good standing without restriction Philippine RN license.
  • Minimum of one (1) year diverse clinical experience or prior experience in medical bill review or claim/case review.
  • Good communication skills.
  • Proficient in word processing software applications.
  • Analytical skills - Ability to perform basic bill review according to standard operating procedures (SOP).
  • Maintains high degree of professionalism and confidentiality.
  • Ability to multi-task, prioritize and manage time effectively.
  • Interpersonal skills - Able to work independently and as a team member.
  • Keen attention to details.
  • Must complete continuing education requirements mandated the Professional Regulation Commission.
  • Must complete courses as outlined by Crawford Educational Services.

  • Project Nurse

    5 days ago

    Iloilo City, Western Visayas, Philippines R-II Builders Inc. Full time ₱600,000 - ₱800,000 per year

    provides on-site primary healthcare, first aid, and emergency response for workers, focusing on occupational health and compliance with safety standards. Responsibilities include managing injuries, monitoring employee health, maintaining medical records, ensuring site health programs are followed, and supporting the EHS team by reporting incidents. The role...

  • Clinical Program Nurse I

    5 days ago

    Iloilo City, Western Visayas, Philippines Crawford & Company Full time ₱180,000 - ₱250,000 per year

    Responsible for auditing in-patient and/or surgical bills to promote excellence in medical bill review and process improvement.Medical Bill ReviewProcesses inpatient and/or surgical bills by adhering to the given standard operating procedures (SOP) and turnaround time to complete the task.Performs bill review process by utilizing appropriate...

  • Company Nurse

    3 days ago

    Iloilo City, Western Visayas, Philippines ADA Full time ₱1,200,000 - ₱2,400,000 per year

    About ADAADA is a leading data and artificial intelligence (AI) company that designs and executes integrated digital, analytics, and marketing solutions. We operate in 11 markets in Asia and partner with leading brands to drive their data and digital maturity.Job SummaryWe are seeking a qualified Occupational Health Nurse (OHN) to support our workplace...

  • Clinic Nurse Supervisor

    5 days ago

    Lapu-Lapu City, Central Visayas, Philippines The Hospital @ Maayo Full time ₱900,000 - ₱1,200,000 per year

    Key Responsibilities:Supervise and lead the clinic nursing team in delivering high-quality and compassionate patient care.Monitor and ensure compliance with clinic protocols, nursing standards, and safety regulations.Coordinate with physicians and administrative staff to facilitate smooth clinic operations.Create staff schedules, delegate tasks, and manage...

  • Company Nurse

    1 week ago

    Iloilo City, Western Visayas, Philippines Qualimed Corporate Health Solutions Full time ₱400,000 - ₱600,000 per year

    Administer first aid treatments and provide medications for all employees.DO admin task which is related to clinic managementMaintain all employee's medical recordsRegistered nurseWilling to be assigned as a Company NurseSite: ILOILOAddress: SM Strata 18th Flr. Sm Strata tower, Benigno Aquino Avenue Service Road, Madurriao IloiloSchedule: Shifting...

  • Clinic Nurse

    3 days ago

    Cebu City, Central Visayas, Philippines Strategic Office Support Inc. Full time ₱900,000 - ₱1,200,000 per year

    We're looking for a dedicated Clinic Nurse to support our Occupational Safety and Health team in a dynamic, fast-paced environment.What You'll Do:Deliver on-site medical care, first aid, and immediate emergency response to employees during night shifts.Monitor, assess, and manage employee health concerns; facilitate timely referrals to external healthcare...

  • Clinical Nurse

    4 days ago

    Cebu City, Central Visayas, Philippines J. Plazo Staffing Corp Full time ₱360,000 per year

    J. Plazo Staffing Corp is hiring a Full time Clinical Nurse role in Cebu City, Central Visayas. Apply now to be part of our team.Job summary:Flexible hours available1 year of relevant work experience required for this roleExpected salary: ₱30,000 per monthQualifications:Candidate must possess at least Professional License (Passed Board/Bar/Professional...

  • Staff Nurse, RN

    5 days ago

    Iloilo City, Western Visayas, Philippines Caring One Iloilo Inc Full time ₱250,000 - ₱450,000 per year

    Position: Call Center Nurse (Advance Urology Institute)Reports to: Team LeadJob Purpose:Virtually serve as the first point of contact for patients, ensuring a positive and efficient experience.Provide virtual administrative support to the clinic by managing patient records, scheduling, and insurance verification if applicable.Assist in resolving patient...

  • PHRN Trainee

    2 weeks ago

    Iloilo City, Western Visayas, Philippines Elevance Health Full time ₱600,000 - ₱1,200,000 per year

    Position Title:PHRN TraineeShift:Job Description:Responsible for serving in an interim basis as a nurse trainee in the USRN Clinical Academy while obtaining NCLEX certification and USRN license prior to being deployed to a USRN function.Primary duties may include, but are not limited to:Attend review and USRN Academy Program for purposes of preparing for the...

  • Aesthetic Nurse

    3 days ago

    Bacolod City, Western Visayas, Philippines Essence Derm Aesthetic Center Full time ₱200,000 - ₱240,000 per year

    Essence Derm Aesthetic Clinic (BACOLOD BRANCH) is seeking a highly skilled and experienced Aesthetic Nurse / Manager to lead our team of professionals in providing exceptional patient care and customer service.Candidate will be responsible for overseeing the daily operations of our clinic, managing staff schedules, supervising our team of aestheticians, and...