Qualifications
Must have an active NCLEX License (US Registered Nurse) and PRC License (Philippine Registered Nurse.
Must have at least 3 months of clinical experience as a Registered Nurse
Must be willing to work at the office or WFH based on company business needs.
Must have good computer skills and can type at least 25wpm.
Must have a stable active hard wired internet connection at home.
Job Responsibilities
Review service requests to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits and contracts.
Route cases to client medical staff for further review when a service or admission does not meet medical necessity, place of service, or benefit criteria.
Work with clinical reviewers and medical directors in interpreting appropriateness of care and conducting PSCCR claims review utilizing the member’s benefit contract and health plan guidelines.
Process incoming requests, collection of information needed for review form providers.
Determine contract and benefit eligibility, obtain intake demographic information from callers and/or faxes.
More Information
40,000 - 70,000
Full Time
Voice - Non-voice - Chat - Email
WFH - Hybrid - Onsite
Alabang, Antipolo, Bacolod, Bacoor, Baguio, Batangas City, Bucalan, Cagayan De Oro, Cebu City, Clark Pampanga, Davao City, Iloilo, Imus Cavite, Makati, Mandaluyong, Pasay, Pasig, Quezon City, Sucat, Taguig, Puerto Princesa, Lucena, Bohol, Tacloban, Tarlac