USRN (US Registered Nurse)

• Review service requests to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits and contracts.
• Route cases to client medical staff for further review when a service or admission does not meet medical necessity, place of service, or benefit criteria.
• Work with clinical reviewers and medical directors in interpreting appropriateness of care and conducting PSCCR claims review utilizing the member’s benefit contract and health plan guidelines.
• Process incoming requests, collection of information needed for review form providers.
• Determine contract and benefit eligibility, obtain intake demographic information from callers and/or faxes.

Requirements

• Must be a USRN (USA Registered Nurse) and PHRN with active licenses.
• Must have at least 1 year clinical experience.
• Work in Metro Manila: QC, Pasay, Pasig, Makati and Alabang.
• Limited slots per site and different accounts.
• Temporary Work From Home setup and must be amendable to working at office when needed or after the pandemic.
• Must have a stable active hard wired internet connection at home.