Utilization Review Nurse

UST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. Our BPaaS solutions manage complex admin tasks, allowing our customers to prioritize members' well-being. With our commitment to simplicity, honesty, and leadership, we navigate challenges with our customers to achieve affordable health care...

Join Access Healthcare Manila as aDRG Nurse Auditor. We are seeking talented individuals to join our team and help drive our success. Apply now and take the next step in your career today. We will provide free training on the client's medical billing software to perform this role.Tasks:Conduct initial audit reviews to validate billed diagnoses and DRG code...

Join Access Healthcare Manila as a DRG Nurse Auditor. We are seeking talented individuals to join our team and help drive our success.Apply now and take the next step in your career today. We will provide free training on the client's medical billing software to perform this role.Tasks:Conduct initial audit reviews to validate billed diagnoses and DRG code...

Key ResponsibilitiesReview patient records and provider notes to validate clinical necessityComplete prior authorization forms and submit to payers via online portals or faxFollow up on status of submitted requests and escalate delays appropriatelyMaintain documentation accuracy and compliance with turnaround time requirementsBalance quality of care with...

Key ResponsibilitiesReview patient records and provider notes to validate clinical necessityComplete prior authorization forms and submit to payers via online portals or faxFollow up on status of submitted requests and escalate delays appropriatelyMaintain documentation accuracy and compliance with turnaround time requirementsRequirementsActive USRN...

Position SummaryThe Prior Authorization Nurse (PHRN) will support the review and submission of prior authorization requests for behavioral health treatments, medications, or services. The nurse will review clinical documentation to ensure accuracy and medical necessity, complete required payer forms, and work closely with administrative support staff to...

USRN – Nurse TriageWork set up: On-site in BGC TaguigWork shift: US Time Zone; Must be open to Night ShiftSalary:2-4 yrs Clinical Experience: 40K-50K Package5-6 yrs Clinical Experience: 60K- 65KpackageStart date: Immediately/ ASAP Joiners onlyHeadcounts: 2-4 yrs experience is 5 HC, 5-6 yrs experience is 5 HCPosition Summary:The Nurse Triage USRN will serve...

Job Summary: We are seeking a dynamic and experiencedClinical Nurse Trainer (USRN)to lead onboarding, skills development, and ongoing training for registered nurses supporting telephonic triage, utilization management, prior authorization, and administrative clinical support functions. The ideal candidate will combine clinical knowledge, adult learning...

Benefits:20 Paid Time Off (PTO) per yearAnnual AppraisalAnnual Performance Based IncentiveWeekends offHMO plus 2 FREE dependentsGroup life insurancePosition Summary:The CDI Physician Reviewer is responsible for improving overall quality and completeness of clinical documentation to accurately reflect patient severity of illness and risk of mortality through...

Benefits:20 Paid Time Off (PTO) per yearAnnual AppraisalPerformance Based IncentiveWeekends offHMO with FREE DependentsGroup life insurancePosition Summary:The CDI Physician Reviewer is responsible for improving overall quality and completeness of clinical documentation to accurately reflect patient severity of illness and risk of mortality through extensive...