Clinical Utilization Review Nurse II

Crawford & Company; Manila; On-site; PHP 300,000 - 550,000; Full time

Job summary

Crawford & Company in Manila is seeking a detail-oriented RN reviewer to assess medical information for medical necessity and appropriateness according to established standards.

The role focuses on evaluation of medical information, collaboration with peers, and adherence to SOPs, with emphasis on confidentiality and professional communication with internal and external customers. A Philippine RN license and at least one year of clinical experience are required.

Qualifications

• Bachelor's degree in Nursing.
• Active Philippine RN license in good standing.
• Minimum 1 year clinical experience or medical bill review/case review experience.
• Strong communication skills.
• Proficient in word processing software.
• Analytical skills for basic bill review per SOP.
• Maintains professionalism and confidentiality.
• Ability to multi-task, prioritize and manage time.

Responsibilities

• Evaluate medical information and apply criteria to utilization review.
• Collaborate with peer physicians to resolve cases.
• Document pertinent information in communications for determinations.
• Adhere to SOPs and turnaround times in reviews.
• Communicate policies to internal/external customers as needed.
• Protect confidentiality per Crawford Code of Conduct.

Skills

Good communication

Analytical skills

Interpersonal skills

Multi-tasking

Attention to detail

Time management

Education

Bachelor's degree in Nursing

Tools

Microsoft Word

Job description

Crawford & Company in Manila is seeking a detail-oriented RN reviewer to assess medical information for medical necessity and appropriateness according to established standards.

The role focuses on evaluation of medical information, collaboration with peers, and adherence to SOPs, with emphasis on confidentiality and professional communication with internal and external customers. A Philippine RN license and at least one year of clinical experience are required.