PH Registered Nurse (Appeals & Denials) | Manila

Nezda Technologies, Inc.; Pasig; In loco; PHP 300.000 - 520.000; Tempo pieno

Descrizione del lavoro

Nezda Technologies, Inc. is seeking a Philippine Registered Nurse to join our healthcare team in hospital-based care and utilization management reviews.

You will apply your clinical knowledge and leverage InterQual or MCG criteria to promote appropriate, high-quality patient care. The role requires at least one year of hospital experience and one year of utilization management review, with strong attention to detail and excellent communication skills.

Competenze

• Must be a licensed Philippine Registered Nurse.
• Minimum one year hospital experience.
• Minimum one year of utilization management review experience.
• Experience using InterQual or MCG criteria.
• Strong clinical judgment and attention to detail.
• Effective communication skills.

Mansioni

• Review clinical information and assess medical necessity using InterQual or MCG guidelines.
• Apply nursing knowledge and hospital experience to utilization management decisions.
• Collaborate with healthcare providers and internal teams to clarify clinical information and support care coordination.
• Maintain accurate, timely, and confidential clinical documentation.
• Escalate complex cases according to established policies and procedures.

Conoscenze

Registered Nurse

Utilization management

InterQual/MCG criteria

Clinical assessment

Communication

Formazione

Philippine Nursing Licensure

Strumenti

InterQual criteria

MCG criteria

Descrizione del lavoro

About the role

Join our healthcare team as a Philippine Registered Nurse supporting hospital-based care and utilization management review. You will apply your clinical knowledge and experience with InterQual or MCG criteria to promote appropriate, high-quality patient care.

Key responsibilities

• Review clinical information and assess medical necessity using InterQual or MCG guidelines.

• Apply nursing knowledge and hospital experience to utilization management decisions.

• Collaborate with healthcare providers and internal teams to clarify clinical information and support care coordination.

• Maintain accurate, timely, and confidential clinical documentation.

• Escalate complex cases according to established policies and procedures.

What we're looking for

• Philippine Registered Nurse qualification.

• At least one year of hospital experience.

• At least one year of utilization management review experience.

• Experience using InterQual or MCG criteria.

• Sound clinical judgment, strong attention to detail, and effective communication skills.