Clinical Program Nurse III - Case Management & Rehab

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

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.