Clinical Program Nurse III

Crawford; Iloilo; On-site; PHP 350,000 - 550,000; Full time

Job summary

Crawford in Iloilo, Philippines is seeking a Nurse Case Manager to assess medical records and coordinate proactive case management services. You will analyze case data, define client needs and recommendations to support rehabilitation goals and return to work.

The role requires both Philippine RN licensure and US RN licensure, plus 2+ years of clinical experience or prior medical bill review exposure; strong communication and confidentiality are essential.

Qualifications

• Active Philippine RN license in good standing; US RN license from any mainland state is required.
• Minimum of two years diverse clinical experience or prior Medical Bill Review experience.
• Excellent verbal communication skills and customer orientation.
• Analytical skills to perform bill review per SOP.
• Ability to deliver excellent customer service.
• Active listening and phone handling skills.
• Maintains high degree of professionalism and confidentiality.
• Ability to multi-task, prioritize and manage time effectively.

Responsibilities

• Assess existing medical records to provide proactive case management.
• Analyzes and reviews case records; defines client needs and problems.
• Provide opinions on costs, treatment plan, outcome and rehabilitation goals.
• Interprets medical records and test results for appropriate assessments.
• Reviews cases with supervisor monthly for guidance.
• Performs job site evaluations to facilitate case management.
• Upholds Crawford policies and communicates with internal/external customers.
• Establishes professional relationships with clients and maintains contact on case activity.
• Performs peer reviews and independent medical examination; meets QA targets.
• Handles problem resolution and refers beyond authority when needed.

Skills

Verbal communication

Customer orientation

Active listening

Phone handling

Analytical skills

Multi-tasking

Interpersonal skills

Critical thinking

Education

Bachelor's degree in Nursing

Tools

Word processing software

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.