USRN Surgical/OR/Bill Review Nurse

Shearwater Health; Metro Manila; Hybrid; PHP 3,141,000 - 4,397,000; Full time

Benefits offered by this job

Hybrid Work Setup

HMO on Day 1 with 2 dependents

Group Life Insurance

Annual Salary Increase

Quarterly Performance Bonus

Service Incentive Leave (SIL) with LE

Visa Sponsorship & Work Abroad through

Nurse Compass Program*

Job summary

The USRN Surgical/OR/Medical Bill Review Nurse at Shearwater Health is responsible for performing medical necessity reviews of prospective, concurrent, and retrospective cases such as medical treatments, auto-injury related requests, hospitalization, home care, and inpatient/outpatient treatment plans, following client contracts and company policies.

Join a global healthcare partner with visa sponsorship opportunities and a strong focus on quality and cost-effective care, supported by a

Qualifications

• Active US nursing license (Mainland)
• At least 2 years of OR/Surgical experience in a hospital setting
• Experience in nursing auditing, utilization review and bill review preferred
• Experience in PPO provider appeals, re-pricing, surgery review, by report and RNE review preferred
• Experience with Strataware preferred

Responsibilities

• Perform medical necessity reviews for proposed prospective, concurrent, and retrospective cases such as medical treatments, auto-injury related requests, hospitalization, home care, and inpatient/outpatient treatment plans.
• Ensure reviews align with client contract rules and company policies to facilitate quality and cost-effective care.

Skills

US Nursing License

OR/Surgical experience

Nursing auditing

Utilization review

PPO appeals

Re-pricing

RNE review

Strataware

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*
• up to $12,000 in program bonuses, including:
• $1,000 upon I-140 filing
• $1,500 annual milestones
• $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 Surgical/OR/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 of recent OR/Surgical experience in a hospital setting required
• Preferably (2) years of experience in daily application of nursing auditing, utilization review and bill review, but not required
• Preferably with prior experience in PPO provider appeals, re-pricing, surgery review, by report and RNE review
• Preferably with experience in utilization of Strataware, but not required