Clinical Program Nurse III

Crawford & Company; Iloilo City; On-site; PHP 600,000 - 1,000,000; Full time

Job summary

Crawford & Company is seeking a Nursing professional in the Philippines to provide proactive case management by assessing medical records and coordinating care. The role involves evaluating medical status, costs, and rehabilitation needs, with emphasis on confidentiality and teamwork.

The ideal candidate holds a Nursing degree with active Philippine RN license and US license, plus 2+ years of clinical or medical bill review experience, strong communication skills, and proficiency in document

Qualifications

• Bachelor's degree in Nursing.
• Active Philippine RN license in good standing; US RN license from any mainland state.
• Minimum of two years clinical experience or prior medical bill review experience.
• Excellent verbal communication and customer orientation.
• Proficient in word processing software.
• Analytical and critical thinking skills; able to follow SOP.
• Strong confidentiality and professionalism.
• Ability to multi-task and manage time effectively.
• Strong interpersonal skills and teamwork.

Responsibilities

• Provide proactive case management by assessing medical records.
• Analyze and review case records, evaluate client’s medical status, and define needs and problems.
• Offer opinions on case costs, treatment plan, outcomes, and rehabilitation recommendations.
• Interpret medical records and test results to support assessments.
• Review cases with supervisor monthly to obtain directions.
• Perform job site evaluations to facilitate case management.
• Communicate Broadspire policies to internal and external customers.
• Maintain professional relationships with clients and timely updates on case activity.

Skills

Verbal communication

Customer service

Analytical thinking

Multitasking

Time management

Interpersonal skills

Attention to detail

Active listening

Critical thinking

Teamwork

Education

Bachelor's degree in Nursing

Tools

Word processing (MS Word)

Job description

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.
  • Met 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.
• Keen attention to details.