USRN

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.
• Active RN license and direct patient care experience required.
• Clinical setting includes inpatient hospital, outpatient hospital or clinic.
• Preferably 1 year of customer service or call-center experience (advantage).

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

• Responsible in collaborating with healthcare providers and members to promote quality member outcomes, to optimize members’ benefits, and to promote effective use of resources
• Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and may steer members to appropriate providers, programs or community resources
• Work with medical directors in interpreting appropriateness of care

Responsibilities:

• Responsible in collaborating with healthcare providers and members to promote quality member outcomes, to optimize members’ benefits, and to promote effective use of resources
• Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and may steer members to appropriate providers, programs or community resources
• Work with medical directors in interpreting appropriateness of care

Requirements:

• BS Nursing (BSN) Degree
• Active US State License holder
• A minimum of three (3) months’ of prior working experience as a Registered Nurse in a clinical setting required
• Three months is equivalent to 480 hours of working experience as an RN
• Working experience as a Registered Nurse means holding an active RN license and providing direct patient care
• Clinical setting includes inpatient hospital, outpatient hospital or clinic
• Preferably (not a requirement, just an advantage) with 1 year of customer service or call-center experience and minimum of work experience

What we offer:

• Work in the Philippines, be with your family while earning good income!
• Healthcare Insurance (HMO) & Life Insurance coverage from day 1 of employment
• Expanded maternity leave up to 120 days*
• Flexible Working Arrangements
• Employee Stock Purchase Plan
• Healthy and Encouraging Work Environment
• Allowances
• Loyalty, Christmas Gift, Inclusion and Diversity Benefits
• Night Differential
• Retirement Plan