Remote US Registered Nurse – Medical Necessity & Case Review
Shearwater CPO® - Home of Clinicians
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Benefits offered by this job
Job summary
The US Registered Nurse role at Shearwater CPO® - Home of Clinicians is responsible for medical necessity review of proposed care across various settings, ensuring compliance with client contracts and company policies. Candidates must hold an active PRC and US Nursing License, with at least one year of hospital bedside experience, and be willing to work from home from Philippine locations.
You will collaborate with case managers, process authorizations, and support care management while
Qualifications
- Active PRC license in the Philippines.
- US Nursing License required.
- At least 1 year of recent hospital bedside care experience.
- Familiarity with the US healthcare system and documentation requirements.
Responsibilities
- Perform medical necessity reviews for prospective, concurrent, and retrospective cases.
- Review treatment plans for medical necessity and cost-effectiveness.
- Coordinate with care teams and ensure compliance with client rules and company policies.
- Communicate effectively with healthcare providers and patients.
Skills
Job description
The US Registered Nurse role at Shearwater CPO® - Home of Clinicians is responsible for medical necessity review of proposed care across various settings, ensuring compliance with client contracts and company policies. Candidates must hold an active PRC and US Nursing License, with at least one year of hospital bedside experience, and be willing to work from home from Philippine locations.
You will collaborate with case managers, process authorizations, and support care management while
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