Experienced USRN

1 day ago

Manila, National Capital Region, Philippines Vee Healthtek Full time ₱600,000 - ₱800,000 per year

Company Description

Vee Healthtek delivers transformative solutions to healthcare organizations, leveraging industry expertise and a results-driven approach to provide maximum value. We specialize in creating customized strategies that address unique organizational challenges and unlock growth opportunities. By employing technology-driven services, we optimize workflows, enhance operational efficiency, and streamline business processes. With a proven track record of success, Vee Healthtek is a trusted partner for healthcare organizations seeking innovation and sustainable development. For more information, visit Vee Healthtek.

USRN Case Manager Nurse

Overview:

Responsible for coordinating patient care, liaising with physicians, insurance providers, patients, and internal teams to ensure efficient case management and compliance with regulations.

Key Responsibilities

  • Manage cases, including prior authorizations for drugs and procedures per hospital policy.
  • Coordinate and complete all case management activities.
  • Ensure patient information confidentiality in compliance with HIPAA.
  • Handle outpatient authorizations, denial letters, and appeals.

Qualifications

  • BS Nursing graduate:
    USRN - NY license required
    .
  • Minimum
    2 years hospital nursing or case management experience
    in a US healthcare setting.
  • Strong communication skills for clinical discussions and documentation.
  • High integrity and adherence to confidentiality and organizational policies.
  • Knowledge of payer systems, utilization management, insurance terminology, InterQual, and Milliman guidelines (preferred).
  • Clinical competence in hospital care and care coordination.
  • Ability to apply InterQual criteria for inpatient/outpatient cases and write effective appeal letters.
  • Proficient in computer and software applications.

Location: Ortigas, Pasig City (at the back of SM Mega Mall) || 100% onsite || Night shift

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