Experienced USRN - NY

Company Description

Vee Healthtek delivers transformative solutions to healthcare organizations, leveraging industry expertise and a results-driven approach to provide maximum value. We specialize in creating customized strategies that address unique organizational challenges and unlock growth opportunities. By employing technology-driven services, we optimize workflows, enhance operational efficiency, and streamline business processes. With a proven track record of success, Vee Healthtek is a trusted partner for healthcare organizations seeking innovation and sustainable development. For more information, visit Vee Healthtek.

Overview:

Responsible for coordinating patient care, liaising with physicians, insurance providers, patients, and internal teams to ensure efficient case management and compliance with regulations.

• Manage cases, including prior authorizations for drugs and procedures per hospital policy.
• Coordinate and complete all case management activities.
• Ensure patient information confidentiality in compliance with HIPAA.
• Handle outpatient authorizations, denial letters, and appeals.

• BS Nursing graduate: USRN - NY license required.
• Minimum 2 years hospital nursing or case management experience in a US healthcare setting.
• Strong communication skills for clinical discussions and documentation.
• High integrity and adherence to confidentiality and organizational policies.
• Knowledge of payer systems, utilization management, insurance terminology, InterQual, and Milliman guidelines (preferred).
• Clinical competence in hospital care and care coordination.
• Ability to apply InterQual criteria for inpatient/outpatient cases and write effective appeal letters.
• Proficient in computer and software applications.

Location: Ortigas, Pasig City (at the back of SM Mega Mall) || 100% onsite || Night shift