We're looking for a USRN Care Manager to join our Insurance Operations team at MBPS. In this role, you will evaluate medical documentation and claim information against policy terms and conditions to determine eligibility for insurance benefits. You will interpret policy language, analyze medical evidence, and make accurate claim decisions while ensuring compliance with contractual and regulatory requirements.
Position Responsibilities
- Assess clinical needs and determine initial eligibility for long-term care benefits using clinical evidence and established guidelines.
- Review onsite/virtual assessments, functional and cognitive screening results, and supporting documentation to make benefit eligibility decisions.
- Monitor ongoing claims, particularly those with high-risk activity, and conduct clinical follow-ups in accordance with current protocols.
- Collaborate with senior care management and cross-functional teams to ensure accurate claim decisions and provide excellent customer service.
- Maintain up-to-date knowledge of clinical protocols and guidelines by completing required training programs.
- Participate in regular meetings, one-on-ones, and other team activities to support operational goals and continuous improvement.
Required Qualifications
- Active Philippine Registered Nurse (PHRN) and US Registered Nurse (USRN) licenses, with the USRN license valid in any U.S. state.
- Candidates with 1–2 years of recent clinical experience.
- Bachelor's degree in Nursing (BSN).
- Candidates must have a professional license with at least one (1) year of validity remaining prior to expiration.
- Amenable to a fixed night shift schedule.
Preferred Qualifications
- Experience in geriatrics, long-term care (LTC), chronic illness management, claims review, care management, or related clinical settings is an advantage but not required.
- Fresh graduates who have relevant exposure or experience in either of these areas are also welcome to apply.
- Proficiency in Microsoft Office applications and Microsoft Teams; ability to quickly learn new claims and workflow management systems.
- Strong decision-making, assessment, and clinical judgment skills, with the ability to work independently and collaborate effectively within multidisciplinary teams.
- Excellent written and verbal communication skills.
What We Offer
- Professional license renewal expenses are covered through the company's reimbursement program.
- Continuing education and professional development costs are also eligible for reimbursement.
- Opportunities for learning, growth, and career advancement within a global organization.
- A flexible and inclusive work environment that supports well-being and professional success.
When You Join Our Team
- We'll empower you to learn and grow the career you want.
- We'll recognize and support you in a flexible environment where well-being and inclusion are more than just words.
- As part of our global team, we'll support you in shaping the future you want to see.
