RN Case Manager: Care Coordination & Utilization

Carelon Global Solutions Philippines; Western Visayas; On-site; PHP 600,000 - 800,000; Full time

Job summary

Carelon Global Solutions Philippines is seeking a qualified RN with a BSN to collaborate with healthcare providers and members to promote quality outcomes and cost-effective care.

The role involves pre-certification, care coordination, discharge planning, and accreditation support, with opportunities to leverage US state licensure and clinical judgment.

Excellent communication and analytical skills are essential as you navigate medical policy and appropriate treatment settings.

Qualifications

• BSN with current, unrestricted RN license to practice.
• Minimum 1 year of acute care, case management, utilization management, or managed care experience.
• Healthcare certification and/or Master's degree a plus.

Responsibilities

• Perform pre-certification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting.
• Ensure access to medically necessary, quality care in a cost-effective setting.
• Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high-quality, cost-effective care throughout the medical management process.
• Collaborate with providers to assess member's needs for discharge planning and care transitions.
• Facilitate accreditation by understanding accrediting and regulatory standards.

Skills

Oral communication

Written communication

Interpersonal skills

Problem-solving

Facilitation

Analytical thinking

Education

BSN

Active RN license (US states)

Master's degree (advantage)

Healthcare certification (advantage)

Job description

Carelon Global Solutions Philippines is seeking a qualified RN with a BSN to collaborate with healthcare providers and members to promote quality outcomes and cost-effective care.

The role involves pre-certification, care coordination, discharge planning, and accreditation support, with opportunities to leverage US state licensure and clinical judgment.

Excellent communication and analytical skills are essential as you navigate medical policy and appropriate treatment settings.