Utilization Reviewer

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...

We are seeking an experienced Medical Allied Graduate Manager to lead and manage the operational delivery of our UM/UR services for U.S.-based healthcare clientsThis strategic role is responsible for driving service quality, team performance, client satisfaction, and operational excellence across multiple Utilization Review accountsKey...

The Reviewer is responsible for assessing the delivery of medical services to determine if the care provided is appropriate, medically necessary, and of high quality. This includes examination of documents to see if patients are given care consistent with their needs as well as inputting of approved Guidelines and References. The review typically involves...

1 OpeningTaguigRole descriptionDevelop full understanding of each medical and claim payment policy, to ensure accurate diagnosis and procedure code assignment. Understand CMS/regulatory requirements, IBX/AH benefit structure, managed care rules (e.g., HMO Capitation, PPO Network Rules) and other business rules to assure diagnosis and procedure 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...

JOB TITLE: Utilization Management US RN Sr AnalystWORK SET UP: Full On-site in Uptown BGC, TaguigWORK SHIFT: Depends with the client and project but they are looking for someone who can work on a shifting schedule(Salary is confidential but sharing a range here for sourcing purposes only and never share to your candidates, only give them a hint that once...

Philippine Registered Nurse should have: Minimum of 1 year of direct bedside care experience in an acute care hospital setting (excluding clinics), with a strong preference for backgrounds in Emergency Room (ER), Intensive Care Unit (ICU), Medical-Surgical, Neonatal Intensive Care Unit (NICU), or Operating Room (OR) environments At least 1 year of hands-on...

Job Description:Liaise between clients and the insurance/HMO company.Facilitate negotiation and communication related to new and renewal medical insurance.Review and recommend benefits, do analysis for pricing negotiation with provider and client.HMO/Medical Insurance product presentation to clients.Candidate must possess at least a Bachelor's/College Degree...

What to ExpectThe Interconnection Coordinator is responsible for handling several different work streams for customers and Energy projects to reach key milestones through system activation. This includes processing documentation, understanding technical design criteria for submission of utility and AHJ applications, managing a pipeline of projects from...