RN Care Manager: Utilization & Discharge Specialist

Carelon Global Solutions Philippines; Taguig; Sur place; PHP 469 000 - 714 000; Plein temps

Résumé du poste

Carelon Global Solutions Philippines seeks an experienced registered nurse to support care management activities, focusing on pre-certification, discharge planning, and coordinated care across the healthcare continuum.

You will work with clinical reviewers and providers to ensure appropriate, high-quality, cost-effective care in line with medical policy and guidelines. A strong background in acute care or managed care is required.

Qualifications

• Requires BSN and active RN license to practice as a health professional.
• At least 1 year of acute care clinical experience or case management/utilization management experience.
• Healthcare certification and/or Master's degree is a plus.

Responsabilités

• Conducts pre-certification, continued stay review, care coordination, or discharge planning for appropriateness.
• Ensures access to medically necessary, quality healthcare in a cost-effective setting according to contract.
• Consults with clinical reviewers/medical directors to ensure appropriate, cost-effective care.
• Collaborates with providers for discharge planning and care transition; refers plans to reviewers as required.
• Facilitates accreditation by understanding and applying accrediting and regulatory standards.

Connaissances

Oral communication

Written communication

Interpersonal skills

Problem solving

Facilitation

Analytical skills

Formation

BSN

Master's degree (preferred)

Description du poste

Carelon Global Solutions Philippines seeks an experienced registered nurse to support care management activities, focusing on pre-certification, discharge planning, and coordinated care across the healthcare continuum.

You will work with clinical reviewers and providers to ensure appropriate, high-quality, cost-effective care in line with medical policy and guidelines. A strong background in acute care or managed care is required.