Clinical Program Nurse III

Crawford & Company; Philippines; On-site; PHP 279,000 - 469,000; Full time

Job summary

Crawford & Company is seeking a skilled nurse with case management experience to assess medical records and determine patient needs. The role involves collaborating with clients, evaluating treatment plans, and facilitating return-to-work strategies.

Responsibilities include performing medical reviews, conducting site evaluations, and ensuring compliance with Broadspire policies while maintaining confidentiality and professionalism in all interactions.

Qualifications

• Bachelor's degree in Nursing.
• Active Philippine RN license in good standing; US RN license from any mainland state is a plus.
• 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 basic and complex bill reviews per SOP.
• Strong customer service orientation and active listening.

Responsibilities

• Case Management Services: analyze and review case records, assess medical status, define needs and problems.
• Client Relations: maintain timely communication with clients and inform of case direction or required authorizations.
• Business Process Support: conduct peer reviews and independent medical examinations; meet QA targets; escalate beyond authority when needed.
• Protect confidentiality and adhere to company policies in all communications.

Skills

Verbal communication

Customer orientation

Phone handling

Analytical skills

Multitasking

Attention to detail

Professionalism

Confidentiality

Education

Bachelor's degree in Nursing

Tools

Word processing software

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.