Clinical Nurse Case Manager – USRN

Work set-up: 
Full Remote
Contract: 
Work from: 

Offer summary

Qualifications:

Active USRN license, either active or non-active., At least 1 year of clinical or hospital experience., Possession of an RN license., Ability to conduct medical management reviews using client-specific criteria..

Key responsibilities:

  • Conduct utilization management reviews including pre-service, concurrent, and retrospective assessments.
  • Review service requests for compliance with medical policies and member benefits.
  • Utilize client-specific criteria and guidelines to approve or escalate cases.
  • Ensure members have access to necessary, quality healthcare in a cost-effective manner.

Nezda Technologies Inc. logo
Nezda Technologies Inc. Human Resources, Staffing & Recruiting Scaleup https://www.nezdaglobal.com/
201 - 500 Employees
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Job description

Nezda Technologies Inc. is currently hiring for Clinical Nurse Case Manager – USRN.

💰 Salary: P 50,000 – P 68,000 (with Perks and benefits).

❗️ Work Set up: Work From Home

Qualifications:
✅ Active and Non-Active USRN License.
✅ With at least 1 Year Clinical or Hospital Experience.
✅ USRN with RN License.

Job Description:

👉🏻 We are in partnership to multiple companies for this position, so you have an option and which company fits you best.
👉🏻 Please take note that this is a direct employment with no bond.

Primary Responsibility:
👉🏻 Conduct UM pre-service, concurrent, retrospective, out of network, and appropriateness of treatment setting.
👉🏻 Reviews service requests to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits and contracts.
👉🏻 Utilize client specific criteria sets (e.g., Milliman or InterQual), applicable client specific medical policy and client clinical guidelines for decision making to either approve or summarize and route to Client’s nursing reviewer and/or Client’s medical staff for review.
👉🏻 Responsible for conducting medical management review activities that require the review of clinical information against client-specific criteria as noted above but excludes denial determinations.
👉🏻 Ensure member access to medically necessary, quality healthcare in a cost-effective setting according to the contract.
👉🏻 Consult with clinical reviewers and/or U.S. licensed medical directors to ensure medically appropriate, high-quality, cost-effective care throughout the medical management process.

Job Type: Full Time
Job Location: NCR

Required profile

Experience

Industry :
Human Resources, Staffing & Recruiting
Spoken language(s):
English
Check out the description to know which languages are mandatory.

Other Skills

  • Decision Making
  • Time Management
  • Teamwork
  • Communication
  • Problem Solving

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