Registered Nurse - UMR

Job Summary

The Clinical UMR evaluates the appropriateness and necessity of medical treatment through the Utilization Management review process in order to promote quality, outcome-based medical care while providing world-class service to customers in an accurate, efficient and courteous manner.

Education:

1.) Bachelors Degree in NURSING.

B) Qualifications:

1.) For NURSES:

(a) Must be a Philippine Registered Nurse (PHRN)

(b) Philippine-based Nurse must have an active, current and unrestricted Philippine RN license; and an active.

(c) U.S.-based Nurse must have and an active, current, and unrestricted US RN license

(d) Must have an active, current and unrestricted relevant Philippine Professional license issued by the Professional Regulation Commission (PRC); and an active, current, and unrestricted additional Professional License or Certificate in their respective domain expertise such as Certified Medical Coders, or similar, when required in the program he/she is assigned to.

2) Must have relevant years of clinical BPO experience in any of or similar domains of Utilization Management, Case Management, Disease Management, Wellness, Medical Coding and Billing, Pharmacy Benefits Management, Claims Management in any of the U.S. industry sectors of Workers Compensation; Commercial Managed Care; Health, Disability, Life, Property and Casualty Insurance; Accountable Care Organizations (ACOs) or any other sector wherein the work performed is related to the use of clinical knowledge and skills.

3) Position level: at least one (1) to five (5) years or more.

4) Knowledge of nursing principles, techniques, and procedures for the care of patients.

5) Knowledge of medical terminology, anatomy, physiology and concepts of disease

6) Makes sound clinical decisions in a timely manner

7) Skill in providing effective nursing care, assessing patient situations and taking effective courses of action