Clinical Utilization Review Nurse II

Crawco; Iloilo; Sur place; PHP 360 000 - 480 000; Plein temps

Résumé du poste

Crawco is seeking a qualified Registered Nurse to review medical information for medical necessity and appropriateness. You will evaluate medical data, apply utilization criteria, and collaborate with peers to resolve cases while maintaining confidentiality and SOP adherence.

The role requires an active Philippine RN license, a Bachelor’s in Nursing, and at least one year of relevant clinical or medical review experience.

Qualifications

• Bachelor's degree in Nursing is required.
• Active Philippine RN license in good standing is required.
• At least 1 year of diverse clinical experience or prior medical bill review/claim review experience.
• Proficiency in word processing software and strong analytical skills.
• Maintains professionalism and confidentiality; capable of multitasking.

Responsabilités

• Review medical information to determine medical necessity and appropriateness.
• Analyze information and apply criteria to support utilization review.
• Collaborate with peer physicians to facilitate case resolution.
• Document pertinent information in communications to support determinations.
• Follow SOPs and turnaround times for the review process.
• Uphold policies and communicate with internal/external customers as necessary.
• Plan and organize caseload, and refer matters beyond authority when needed.

Connaissances

Analytical skills

Interpersonal skills

Time management

Multitasking

Attention to detail

Formation

Philippine RN license

Bachelor's degree in Nursing

Outils

Microsoft Word

Description du poste

Crawco is seeking a qualified Registered Nurse to review medical information for medical necessity and appropriateness. You will evaluate medical data, apply utilization criteria, and collaborate with peers to resolve cases while maintaining confidentiality and SOP adherence.

The role requires an active Philippine RN license, a Bachelor’s in Nursing, and at least one year of relevant clinical or medical review experience.