UR Nurse (USRN)

Genfinity Philippines, Inc.; Makati; On-site; PHP 600,000 - 900,000; Full time

Job summary

Genfinity Philippines, Inc. seeks a USRN to join our utilization management team at our Makati site. The role focuses on promoting quality medical care through timely, cost-effective evaluation of medical necessity and treatment adequacy.

You will gather data, review ICD-10 coding, communicate with providers and adjusters, and produce management reports. On-site work in Makati is required to support our US-based client and ensure compliance with UR processes.

Qualifications

• Active nursing license in the Philippines and in the mainland US.
• 1 year of experience in Utilization Management/Review.
• Knowledge of ICD-10 codes and utilization review process.
• Strong verbal and written communication, organizational and leadership abilities.
• Proficiency in MS Word and Excel; general computer literacy with dual screens.

Responsibilities

• Facilitate verbal and written communication with employees, employers, providers, and adjusters.
• Gather medical data to evaluate necessity of treatment and functional capabilities.
• Ensure timely processing of billings, utilization issues, and referrals.
• Review admissions and refer cases to peer advisor when standards aren't met.
• Provide reports to management reflecting activities and results.

Skills

Communication

Leadership

Analytical skills

Time management

Interpersonal skills

Organizational skills

Report writing

Tools

MS Word

Excel

Job description

Our US-based client, a premier multiline claims services provider, is looking for USRNs to be part of their team at their Philippine-based site. The role will provide utilization management services for clients, insurers, and injured employees to promote quality medical care in a prompt, cost-effective manner.

Primary Duties and Responsibilities:

• Facilitate verbal and written communication with employees, employers, providers of care, and adjusters.
• Gather medical data to evaluate the necessity of medical treatment and functional capabilities.
• Insure timely processing of billings, utilization issues, and/or referral decisions.
• Resolve, negotiate, and make recommendations regarding medical care.
• Compare medical information to establish criteria (medical standards) and determine appropriateness of treatment and length of treatment.
• Determine appropriateness of referrals to peer advisors.
• Maintain and monitor volume and cost of peer advisor reviews for management report.
• Perform and maintain research, documentation, statistics, and auditing information on all types of medical providers, procedures, scopes of practice, and professional organizations.
• Respond promptly and expertly to telephone inquiries, verbal or written communications from providers, UM department staff, and others.
• Function as a resource to medical audit, other UM department staff, customers, and outside agencies.
• Assist claims professional in compensability issues involving ICD-10 codes, medical service providers, treatment parameters, dates of service, etc.
• Provide appropriate, adequate, and timely reports to management, accurately reflecting activities and results.
• Review application for patient admission and approve admission or refer case to peer advisor for review and course of action when case fails to meet admission standards.
• Attend training/educational classes as appropriate.
• Coordinate activities of staff in supervisor’s absence, where applicable.
• Must actively participate in QM monitoring and strive to achieve departmental standards and objectives.
• Perform other duties and responsibilities as deemed necessary and assigned.

Qualifications:

• An active Nursing license in the Philippines and in the mainland US
• One (1) year of experience in Utilization Management/Review (experience in Workers Compensation is preferred, but not required)
• Demonstrated knowledge of ICD-10 codes, the utilization review process, and use of criteria.
• Excellent verbal and written communication, organizational, and leadership skills.
• Proficiency in MS Word and Excel and general computer literacy, working with dual screens
• Strong analytical, interpersonal, and time management skills are also required
• Willing to report on-site in Makati
  

All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, ethnicity, age, disability, marital status, or any other characteristic protected by law.

Genfinity as an Equal Opportunity Employer, believes in each person’s potential, and we’ll help you achieve yours.

All information will be kept confidential according to EEO guidelines.

Privacy Notice & Consent

We value your privacy. By submitting your information through this form, you are applying for a position at Genfinity Philippines, Inc. and voluntarily providing personal information, including your name, contact details, and resume.

This information will be collected and processed solely for recruitment purposes , including evaluating your qualifications, assessing your skills, verifying your background, and contacting you about your application. As part of the recruitment process, identity verification may be conducted at a later stage i.e. post-offer stage, which may require the collection and review of valid identification documents. Your personal data will be processed in accordance with the Data Privacy Act of 2012.

You have the right to access, correct, or withdraw your data at any time. For more information, please refer to our Privacy Policy or contact our Data Protection Team at [e-mail] .

By submitting this form, I acknowledge that I have read and understood the above Privacy Notice and hereby give my free, informed, and voluntary consent to the collection and processing of my personal information by Genfinity Philippines, Inc. for recruitment purposes.