Job Openings UR Nurse (USRN)

About the job UR Nurse (USRN)

WHAT IS NEXT IN YOUR CAREER IN 2022?

Would working as a pioneer in a new company spark your interest? Are you looking for a position with tremendous growth potential?

Our US-based client, a premier multiline claims services provider, is looking for USRNs to be part of their initial team at their first 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

EARN AS MUCH AS PHP 90,000! (depending on experience)