PHRN Clinical Review Nurse

1 week ago

Pasay P, Philippines AUMTREND PH INC Full time ₱360,000 - ₱396,000 per year

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 identify trends and opportunities for improvement.
  • Collaboration: Work with physicians, medical directors, and other multidisciplinary teams to discuss complex cases.
  • Documentation: Maintain accurate and comprehensive records of all reviews and findings.
  • Compliance: Ensure adherence to all regulatory, accreditation, and company policies, including member information confidentiality.
  • Quality improvement: Participate in quality improvement initiatives, audits, and staff education.
  • Communication: Handle provider calls, fax triage, and work with internal and external clinical support teams.

QUALIFICATIONS:

  • Active PRC - RN License
  • With at least 1 year hospital bedside experience

Job Type: Full-time

Pay: Up to Php33,000.00 per month

Benefits:

  • Health insurance

Ability to commute/relocate:

  • Pasay 1350 P00: Reliably commute or planning to relocate before starting work (Preferred)

Application Question(s):

  • Notice Period:
  • Current and Expected Salary:

Experience:

  • Hospital: 1 year (Preferred)

License/Certification:

  • Nursing license (Preferred)

Work Location: In person

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