Clinical Program Nurse III

Crawford Job Listings - Global; Iloilo; On-site; PHP 420,000 - 650,000; Full time

Job summary

Crawford Job Listings - Global is seeking a Nursing professional to provide proactive case management. You will assess medical records, review cases with a focus on costs and treatment plans, and support rehabilitation and return-to-work processes.

The role requires a Philippine RN license (and US license), a nursing degree, and at least two years in clinical or medical bill review work. Strong communication and analytical skills are essential. This is an on-site position in Iloilo.

Qualifications

• Bachelor's degree in Nursing.
• Active Philippine RN license in good standing; US RN license from any mainland state also required.
• Minimum of two years diverse clinical experience or prior Medical Bill Review experience.
• Excellent verbal communication skills and customer orientation.
• Proficient in word processing software applications.
• Analytical skills for bill review according to SOP.
• Ability to deliver excellent customer service.
• Active listening and phone handling skills.
• Critical thinking and judgement.
• Maintains confidentiality and professionalism.
• Ability to multi-task and manage time effectively.
• Interpersonal skills; able to work independently and as a team.

Responsibilities

• Case management: assess records and define client needs.
• Review case costs, treatment plans, and outcomes; recommend rehab goals.
• Interpret medical records and test results for assessments.
• Monthly file reviews with supervisor for directions.
• Perform job site evaluations to support case management.
• Communicate policy procedures to internal and external customers.
• Establish professional relationships with clients by timely return to work.
• Maintain contact with all parties about case activity and authorization.
• Peer reviews and independent medical examinations.
• Meet monthly production and QA requirements.
• Resolve problems and escalate when needed.
• Uphold Crawford Code of Conduct and confidentiality.

Skills

Verbal communication

Customer orientation

Analytical skills

Word processing

Active listening

Critical thinking

Multi-tasking

Time management

Interpersonal skills

Team player

Education

Bachelor's degree in Nursing

Tools

Microsoft Word

Job description

• Process Code BSI005.003 TCMA
• Equipment Field Dell Wyse 5470 Mobile Thin Client Package with 1 monitor, keyboard, mouse, cables
• Work Station Assignment TBD
• Nurse License US Registered Nurse

Job Description

Responsible for providing proactive case management services by assessing existing medical records.

Responsibilities

• Case Management Services
  • Analyzes and reviews case records, evaluates client's medical status, and defines their needs and problems.
  • Provides opinions regarding case costs, treatment plan, outcome and problem areas, and makes recommendation to facilitate rehabilitation goals and return to work.
  • Utilizes experience and medical resources to interpret medical records and test results, and provide appropriate assessments accordingly.
  • Reviews cases with immediate superior monthly to evaluate files and obtain directions.
  • Performs job site evaluations/summaries to facilitate case management process.
  • Demonstrates knowledge and understanding of Broadspire medical department policies and procedures and ability to communicate same with internal/ external customers as necessary
• Client Relations
  • Establishes professional working relationship with internal and external clients by timely return to work.
  • Maintains contact with all parties involved on case to appraise them of case activity, case direction, or receive authorization for services.
  • Demonstrates knowledge and understanding of Broadspire medical department policies and procedures and ability to communicate same with internal/ external customers as necessary
• Business Process Support
  • Performs peer reviews and independent medical examination.
  • Meets monthly production and quality assessment (QA) requirements.
  • Deals with problem resolution independently by using appropriate research and resources.
  • Refers matters beyond limits of authority and expertise to immediate superior for direction.
  • Upholds the Crawford Code of Conduct by protecting the confidentiality of information.
  • Performs other related tasks as required or needed.
  • Demonstrates knowledge and understanding of Broadspire medical department policies and procedures and ability to communicate same with internal/ external customers as necessary

Qualifications

• Bachelor's degree in Nursing.
• Must have an active and in good standing without restriction Philippine RN license; Has an active and in good standing without restriction US RN license from any mainland state.
• Minimum of two (2) years diverse clinical experience or prior experience in Medical Bill Review.
• Excellent verbal communication skills and customer orientation.
• Proficient in word processing software applications.
• Analytical skills - Ability to perform basic and complex bill review according to standard operating procedures (SOP).
• Ability to deliver excellent customer service.
• Active listening and phone handling skills.
• Critical thinking skills - Ability to make judgements and recommendations.
• 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.