Clinical Program Nurse III

Crawford and Company; Iloilo City; On-site; PHP 300,000 - 600,000; Full time

Job summary

Crawford and Company is seeking a Nurse case manager to provide proactive management by assessing medical records and coordinating care. The role includes reviewing case records, advising on costs and treatment plans, and communicating policies to clients and partners.

The ideal candidate holds a Philippine RN license (also US license preferred), with at least two years of clinical or medical bill review experience. Strong communication, analytical, and confidentiality skills are essential.

Qualifications

• Bachelor's degree in Nursing is required.
• Active and in good standing Philippine RN license;US RN license from any mainland state also required.
• Minimum of two years clinical experience or prior Medical Bill Review experience.
• Excellent verbal communication and customer orientation.
• Proficient in word processing software.
• Analytical skills for bill review per SOP.
• Ability to deliver excellent customer service.
• Strong listening and phone handling skills.
• High professionalism and confidentiality.

Responsibilities

• Analyze and review case records, evaluate medical status, and define needs and problems.
• Provide opinions on case costs, treatment plans, outcomes, and rehab/return-to-work recommendations.
• Interpret medical records and test results for assessments.
• Review cases with supervisor monthly and obtain directions.
• Perform job site evaluations to support case management.
• Communicate Broadspire policies to internal/external customers.
• Establish professional relationships with clients by timely return to work.
• Maintain contact with all parties involved to update on case activity and direction.
• Meet monthly production and QA requirements; resolve issues independently; refer beyond authority as needed.
• Uphold Crawford Code of Conduct and confidentiality.

Skills

Verbal communication

Customer orientation

Word processing

Analytical skills

Active listening

Critical thinking

Confidentiality

Multitasking

Interpersonal skills

Attention to detail

Education

Bachelor's degree in Nursing

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.
  • 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.
• Keen attention to details.