USRN Bill Review Nurse

Shearwater Health; Metro Manila; Hybrid; PHP 2,627,000 - 4,003,000; Full time

Benefits offered by this job

Hybrid work setup

HMO on day 1 with 2 dependents

Group life insurance

Complexity allowance

Annual salary increase

Quarterly performance bonus

Service incentive leave

Work-life integration

Visa sponsorship

Nurse Compass program

I-140 filing bonus

Five-year loyalty bonus

U.S. arrival bonus

Job summary

Shearwater Health is seeking a USRN Medical Bill Review Nurse to evaluate medical necessity for various cases in alignment with client contracts and company policies.

The role requires active US nursing licensure and at least 2 years of OR/surgical experience in a hospital setting, with potential for onsite training followed by work-from-home after ramp-up under a hybrid setup.

Qualifications

• Must have an active US Nursing License (Mainland).
• At least two years of recent OR/Surgical experience in a hospital setting.

Responsibilities

• Review medical necessity for proposed, concurrent, and retrospective cases.
• Assess coverage and contract rules to ensure compliant billing.
• Support cost-effective care through accurate medical bill review.

Skills

US Nursing License

OR/Surgical experience

Medical bill review

Education

US Registered Nurse License

Tools

Strataware

Job description

Let your Passion Lead You at the Home of Clinicians with over 6000+ employees who have trusted us with their careers!

Our Clinicians & Associates advocates for better patient care while enjoying these benefits:

• HybridWorkSetup(Onsitetraining;performancebasedWFHafterramp)
• Competitive Compensation Package
• HMO on Day 1 with 2 dependents upon regularization
• Group Life Insurance
• Complexity Allowance
• Annual Salary Increase
• Quarterly Performance Bonus
• Service Incentive Leave (SIL) with Leave Conversion
• Work-Life Integration
• Visa Sponsorship & Work Abroad through our Nurse Compass Program*
• Earn up to $12,000 in program bonuses, including:
• $1,000 upon I-140 filing
• $5,000 five-year loyalty bonus
• $3,000 U.S. arrival bonus
• Build your U.S. nursing career with Shearwater Health.

Terms and conditions apply.

Job Summary

The USRN Medical Bill Review Nurse role is responsible in performing medical necessity review of proposed prospective, concurrent, and retrospective cases such as medical treatments, auto-injury related request, hospitalization, home care, and inpatient/outpatient treatment plans for medical necessity and efficiently in accordance with the client's-specific contract rules and guidelines and with company's policies, practices and procedures to facilitate quality and cost effective care for the injured employee.

Qualifications:

• Must have an active US Nursing License; Mainland License
• With at least two (2) years ofrecent OR/Surgicalexperiencein a hospital setting required
• Preferably (2) years ofexperiencein daily application ofnurseauditing, utilization review and bill review, but not required
• Preferably with priorexperiencein PPO provider appeals, re-pricing, surgery review, by report and RNE review
• Preferably with experience in utilization of Strataware, but not required