RN Care Coordination & Utilization Specialist

Carelon Global Solutions Philippines; Iloilo; On-site; PHP 250,000 - 450,000; Full time

Job summary

Carelon Global Solutions Philippines is seeking an experienced Registered Nurse to collaborate with healthcare providers and members, promoting appropriate, cost-effective care across the continuum.

You will conduct pre-certification, continued stay reviews, and care coordination, including discharge planning. BSN and active RN license are required; 1 year of acute care or case management experience is expected, with a Master’s degree or related certification as a plus.

Qualifications

• Requires BSN and active unrestricted RN license to practice in applicable states.
• Minimum 1 year of acute care, case management, utilization management, or managed care experience.
• Healthcare-related certification and/or Master’s degree a plus.
• Strong oral, written and interpersonal communication skills.

Responsibilities

• Conducts pre-certification, continued stay review, and care coordination.
• Performs discharge planning and efficiency reviews to ensure appropriate setting of care.
• Collaborates with clinical reviewers/medical directors to ensure quality, cost-effective care.
• Supports accreditation efforts by understanding and applying standards.

Skills

Communication

Problem solving

Interpersonal skills

Education

BSN

Active RN license (US state)

Master’s degree or certifications (a plus)

Job description

Carelon Global Solutions Philippines is seeking an experienced Registered Nurse to collaborate with healthcare providers and members, promoting appropriate, cost-effective care across the continuum.

You will conduct pre-certification, continued stay reviews, and care coordination, including discharge planning. BSN and active RN license are required; 1 year of acute care or case management experience is expected, with a Master’s degree or related certification as a plus.