RN Care Navigator: Quality & Utilization

Siegen HR Solutions; Manila; On-site; PHP 446,000 - 670,000; Full time

Benefits offered by this job

Healthcare Insurance (HMO) & Life Insurance

Flexible Working Arrangements

Employee Stock Purchase Plan

Retirement Plan

Expanded maternity leave up to 120 days

Night Differential

Job summary

A healthcare consulting firm is looking for a Registered Nurse to collaborate with healthcare providers to enhance member outcomes and client resources. The role requires assessing medical necessity and working closely with medical directors to ensure care appropriateness. Candidates must hold a BSN and an active US state license, with at least three months of clinical experience. This position offers competitive benefits, including healthcare insurance from day one and flexible working arrangements.

Qualifications

• Active US State License holder.
• A minimum of three months’ working experience as a Registered Nurse in a clinical setting.
• Preferably with 1 year of customer service or call-center experience.

Responsibilities

• Collaborate with healthcare providers to promote quality member outcomes.
• Assess the medical necessity of various healthcare services.
• Work with medical directors to determine care appropriateness.

Skills

Collaboration with healthcare providers

Assessment of medical necessity

Interpretation of care appropriateness

Customer service skills

Education

BS Nursing (BSN) Degree

Job description

A healthcare consulting firm is looking for a Registered Nurse to collaborate with healthcare providers to enhance member outcomes and client resources. The role requires assessing medical necessity and working closely with medical directors to ensure care appropriateness. Candidates must hold a BSN and an active US state license, with at least three months of clinical experience. This position offers competitive benefits, including healthcare insurance from day one and flexible working arrangements.