PH Registred Nurse
1 day ago
We are seeking a highly skilled and detail-oriented PH Registered Nurse (PHRN) to join our team.
The ideal candidate will have hands-on experience with InterQual, MCG , NCD, and LCD Guidelines
Key Responsibilities
- Conduct clinical reviews of inpatient and outpatient services using InterQual, MCG, NCD, and LCD criteria.
- Analyze patient records to determine the medical necessity and appropriateness of services.
- Collaborate with medical directors and multidisciplinary teams to review complex cases.
- Ensure compliance with regulatory and payer-specific guidelines.
- Document and maintain accurate and comprehensive review records.
- Participate in quality improvement and audit initiatives.
Qualifications
- Active PHRN license
- at least 1 year of clinical nursing experience in utilization review or case management experience preferred.
- Must have minimum acute bedside experience
- Proficient in using InterQual and MCG guidelines.
- Strong working knowledge of NCD and LCD criteria and application.
- Experience in developing or implementing clinical decision trees or algorithms.
Job Type: Full-time
Pay: Php40, Php45,000.00 per month
Benefits:
- Health insurance
- Life insurance
- Opportunities for promotion
- Paid training
- Pay raise
- Promotion to permanent employee
- Transportation service provided
Experience:
- Utilization Review Nurse: 1 year (Required)
- Hospital: 1 year (Required)
Work Location: In person
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