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We are looking for fresh talents for the healthcare information management industry. Someone who wants to make a difference, and be part of something big, something that improves lives. If this sounds like your story, we are a match.

What you can look forward to: 

  • Up to 30,000 USRN Allowance. 
  • Up to 2,800 non-taxable Allowance
  • Temporary Work from Home. Assets provided.
  • Competitive compensation and benefits package
  • Quarterly Incentive Program*, computed as % from annual gross compensation
  • Premium HMO Coverage, covering employee + up to 2 dependents on Day 1 of employment
  • Vacation and sick leaves with annual conversion*
  • Weekends off, fixed night shift schedule for most businesses lines
  • Retirement package eligibility depending on tenure of employment

*Terms and conditions apply

Responsibilities:

 

  • Conducts pre-certification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts;
  • Ensures member access to medical necessary, quality healthcare in a cost effective setting according to contract;
  • Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process;
  • Collaborates with providers to assess members needs for early identification of and proactive planning for discharge planning;
  • Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications; and
  • Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.

Qualifications:

 

  • Must be an active PRC & US Mainland Board of Nursing License;
  • Preferably with 1 year cumulative clinical experience in a hospital / clinical setting. Other clinical line of work (private duty, company / school, ambulance / emergency, etc.) may be considered;
  • With or without 6 months of previous experience in a bpo / healthcare information management account experience in Utilization Management is preferred. Background in a Prior Authorization account is also an advantage for this position;
  • Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

 

To expedite the process of your application, please prepare your government numbers / IDs (SSS, Tin, Philhealth, Pagibig) and NBI Clearance. For candidates applying for Clinical Operations, please also prepare your PRC and/or USRN license numbers / IDs.

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