Job Opportunities in Philippines
October 1, 2024
Crawford & Company
Iloilo City
FULL TIME
GBSC - Clinical Program Nurse II
Summary:
Responsible for reviewing medical information to determine if requested treatment is medically necessary and appropriate according to the given standards.
Job Scope:
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Evaluation of Medical Information
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Analyzes medical information and applies established criterion to facilitate the utilization review process.
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Collaborates objectively with peer physicians to facilitate case resolution.
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Utilizes appropriate resources to perform utilization review process.
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Documents pertinent information in internal and external communications to support utilization management determinations and case resolutions.
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Adheres to the given standard operating procedures (SOP) and turnaround time to complete the review process.
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Demonstrates knowledge and understanding of Broadspire medical department policies and procedures and ability to communicate same with internal/ external customers as necessary.
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Analyzes medical information and applies established criterion to facilitate the utilization review process.
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Business Process Support
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Plans and organizes individual caseload to meet requirements.
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Communicates effectively with persons involved in the review process as needed.
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Refers matters beyond limits of authority and expertise to immediate superior for direction.
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Upholds the Crawford Code of Conduct by protecting the confidentiality of information.
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Performs other related tasks as required or needed.
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Demonstrates knowledge and understanding of Broadspire medical department policies and procedures and ability to communicate same with internal/ external customers as necessary.
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Plans and organizes individual caseload to meet requirements.
- Bachelor’s degree in Nursing.
- Must have an active and in good standing without restriction Philippine RN license.
- Minimum of one (1) year diverse clinical experience or prior experience in medical bill review or claim/case review.
- Must complete continuing education requirements mandated the Professional Regulation Commission.
- Must complete courses as outlined by Crawford Educational Services.
- Good communication skills.
- Proficient in word processing software applications.
- Analytical skills - Ability to perform basic bill review according to standard operating procedures (SOP).
- Maintains high degree of professionalism and confidentiality.
- Ability to multi-task, prioritize and manage time effectively.
- Interpersonal skills - Able to work independently and as a team member.
- Keen attention to details.
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