UR Nurse (USRN)
UR Nurse (USRN)
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Salary Not Disclosed
1 Vacancy
Job Description
Our US-based client a premier multiline claims services provider is looking for USRNs to be part of their team at their Philippine-based site. The role will provide utilization management services for clients insurers and injured employees to promote quality medical care in a prompt cost-effective manner.
Primary Duties and Responsibilities:
- Facilitate verbal and written communication with employees employers providers of care and adjusters.
- Gather medical data to evaluate the necessity of medical treatment and functional capabilities.
- Insure timely processing of billings utilization issues and/or referral decisions.
- Resolve negotiate and make recommendations regarding medical care.
- Compare medical information to establish criteria (medical standards) and determine appropriateness of treatment and length of treatment.
- Determine appropriateness of referrals to peer advisors.
- Maintain and monitor volume and cost of peer advisor reviews for management report.
- Perform and maintain research documentation statistics and auditing information on all types of medical providers procedures scopes of practice and professional organizations.
- Respond promptly and expertly to telephone inquiries verbal or written communications from providers UM department staff and others.
- Function as a resource to medical audit other UM department staff customers and outside agencies.
- Assist claims professional in compensability issues involving ICD-10 codes medical service providers treatment parameters dates of service etc.
- Provide appropriate adequate and timely reports to management accurately reflecting activities and results.
- Review application for patient admission and approve admission or refer case to peer advisor for review and course of action when case fails to meet admission standards.
- Attend training/educational classes as appropriate.
- Coordinate activities of staff in supervisors absence where applicable.
- Must actively participate in QM monitoring and strive to achieve departmental standards and objectives.
- Perform other duties and responsibilities as deemed necessary and assigned.
Qualifications:
- An active Nursing license in the Philippines and in the mainland US
- One (1) year of experience in Utilization Management/Review (experience in Workers Compensation is preferred but not required)
- Demonstrated knowledge of ICD-10 codes the utilization review process and use of criteria.
- Excellent verbal and written communication organizational and leadership skills.
- Proficiency in MS Word and Excel and general computer literacy working with dual screens
- Strong analytical interpersonal and time management skills are also required
- Willing to report on-site in Makati
All qualified applicants will receive consideration for employment without regard to race color religion gender gender identity sexual orientation national origin ethnicity age disability marital status or any other characteristic protected by law.
Genfinity as an Equal Opportunity Employer believes in each persons potential and well help you achieve yours.
All information will be kept confidential according to EEO guidelines.
Privacy Notice & Consent
We value your privacy. By submitting your information through this form you are applying for a position at Genfinity Philippines Inc. and voluntarily providing personal information including your name contact details and resume.
This information will be collected and processed solely for recruitment purposes including evaluating your qualifications verifying your background and contacting you about your application. Your personal data will be processed in accordance with the Data Privacy Act of 2012.
You have the right to access correct or withdraw your data at any time. For more information please refer to our Privacy Policy or contact our Data Protection Team at .
By submitting this form I acknowledge that I have read and understood the above Privacy Notice and hereby give my free informed and voluntary consent to the collection and processing of my personal information by Genfinity Philippines Inc. for recruitment purposes.
Required Experience:
Manager
Employment Type
Full-Time
