Qualifications:
- Active Philippine Registered Nurse (PHRN) with License Required
- 1 Year(s) Minimum of Clinical Nursing Experience (Hospital, Clinic, or Managed Care Setting)
- 6 Month(s) Minimum of Clinical Process Outsourcing Experience and Background Handling Clinical Role Focusing on Clinical Appeals and Utilization Management and Other Related Function
- Strong Clinical Knowledge Particularly in Medical Necessity Review and Interpretation of Clinical Documentation
- Demonstrates Excellent Verbal and Written Communication Skills
- Ability to Manage Multiple Case(s)
- Proficient in Basic Microsoft Office Application(s) such as Word, Excel, and Outlook
Preferred Qualifications (not required)
- Experience Handling Medicare Part C or US-Based Appeals Case(s)
- Familiarity with CMS Guideline(s), NCQA Standard(s), or URAC Regulation(s)
- Experience in Using Appeals Management Platform(s) (VAM and Salesforce Health Cloud)
Others:
- Full-time employment
- Full-Onsite (non-negotiable)
- Fixed Night-shift
- Competitive Salary + Sign-on Bonus + Benefits
