USRN Utilization Management Senior Analyst
with 150K Signing Bonus
Job Responsibilities:
Grievance & Appeals
- Creates complete appeal records for external appeal reviews, using standardized Independent Review Entity (IRE) forms and including all required documentation.
- Creates a detailed case summary in narrative format for each appeal.
- Submits cases as directed for each applicable geographic region.
- Presents verbal and written case summaries to client's Grievance Team and client Medical Directors.
- Completes assignments within client-designated turnaround times.
Qualifications:
- Bachelor of Science Nursing (BSN) degree or General Nursing & Midwifery (GNM) Diploma or Basic Bachelor of Science (BSC) in Nursing degree or Associate Nursing Degree or Nursing Diploma
- Holds current and unrestrictedUS Registered Nurse license(required)
- 3 months clinical experience (480 hours of working experience as a RN)
- Work experience as an active RN license and providing direct patient care
- Clinical setting includes inpatient hospital, outpatient hospital or community clinic
- No state license required
- Minimum 6 months of UM experience.
- Work experience such as TL, QA, Trainer and Claims are preferred and good to have skills only
Location: Taguig City
Work Schedule: TBD
Work Setup: Must be amenable to work onsite/hybrid (depends on the business needs)
