Clinical Program Nurse II

2 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

    4 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

    3 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...

  • Clinic Nurse Supervisor

    3 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

    2 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...

  • NURSE with OHNAP

    2 weeks ago

    Iloilo City, Western Visayas, Philippines Frey-Fil Corporation Full time ₱600,000 - ₱800,000 per year

    Duties and Responsibilities:Provide first aid treatment and emergency medical care to employees at the project site.Monitor and maintain workers' health through regular medical checks, health counseling, and preventive programs.Maintain and update medical records, incident reports, and health-related documentation.Assist in the implementation of health,...

  • NURSE (Pavia, Iloilo)

    2 weeks ago

    Iloilo City, Western Visayas, Philippines Frey-Fil Corporation Full time ₱80,000 - ₱120,000 per year

    Duties and Responsibilities:Provide first aid treatment and emergency medical care to employees at the project site.Monitor and maintain workers' health through regular medical checks, health counseling, and preventive programs.Maintain and update medical records, incident reports, and health-related documentation.Assist in the implementation of health,...

  • Clinic Nurse

    2 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

    3 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...

  • Registered Nurse – Seeking NCLEX Sponsorship – Relocation to U.S

    4 weeks ago

    Iloilo City, Western Visayas, Philippines Conexus MedStaff Full time

    Are you a registered nurse seeking a rewarding career in the U.S.? Do you have current bedside experience at a secondary or tertiary hospital? Conexus MedStaff is ready to sponsor your NCLEX license and offer you a rewarding career in the United States.Conexus offers a comprehensive NCLEX Sponsorship Program for registered nurses. We pay all expenses related...

  • Registered Nurse – Seeking NCLEX Sponsorship – Relocation to U.S

    4 days ago

    Iloilo City, Western Visayas, Philippines Conexus MedStaff Full time $100,000 - $120,000 per year

    Are you a registered nurse seeking a rewarding career in the U.S.? Do you have current bedside experience at a secondary or tertiary hospital? Conexus MedStaff is ready to sponsor your NCLEX license and offer you a rewarding career in the United States.Conexus offers a comprehensive NCLEX Sponsorship Program for registered nurses. We pay all expenses related...