RN Utilization Review & Care Coordination

Carelon Global Solutions Philippines; Taguig; Presencial; PHP 600.000 - 900.000; Jornada completa

Descripción de la vacante

Carelon Global Solutions Philippines is seeking a skilled healthcare professional to join our clinical management team. The role focuses on promoting appropriate, cost-effective care by evaluating medical necessity for inpatient and outpatient services and guiding members to appropriate resources.

The successful candidate will perform pre-certification, continued stay reviews, care coordination, discharge planning, and collaboration with medical directors to ensure quality outcomes and

Formación

• BSN/Active RN license required; Master’s degree or healthcare certification a plus.
• 1 year of acute care, case management, utilization management, or managed care experience preferred.
• Strong oral, written, and interpersonal communication, problem-solving, facilitation, and analytical skills.

Responsabilidades

• Conduct pre-certification, continued stay review, care coordination, or discharge planning for appropriateness.
• Ensure access to medically necessary, quality care in cost-effective settings.
• Consult with clinical reviewers/medical directors to ensure appropriate, high-quality, cost-effective care.
• Collaborate with providers for discharge planning and care transition; refer plans to reviewers as required.
• Support accreditation by understanding accrediting and regulatory standards.

Conocimientos

Communication skills

Problem solving

Facilitation

Analytical thinking

Educación

BSN degree

RN license

Master’s degree (preferred)

Descripción del empleo

Carelon Global Solutions Philippines is seeking a skilled healthcare professional to join our clinical management team. The role focuses on promoting appropriate, cost-effective care by evaluating medical necessity for inpatient and outpatient services and guiding members to appropriate resources.

The successful candidate will perform pre-certification, continued stay reviews, care coordination, discharge planning, and collaboration with medical directors to ensure quality outcomes and