Offer summary

Qualifications:

Active USRN and PHRN licenses are required., At least 1 year of clinical or hospital experience., Strong understanding of medical policies and criteria., Excellent communication and review skills..

Key responsibilities:

Review service requests for compliance with medical policies.

Conduct medical management reviews based on clinical information.

Consult with clinical reviewers and medical directors to ensure quality care.

Maintain accurate documentation of review activities.

In 2014, Nezda started with a vision to be one of the top recruitment companies in the Philippines, fast forward to several years after, we are now one of the largest recruitment firms in Philippines, with offices covering Luzon, Visayas, Mindanao and Malaysia. Nezda is now known to bridge qualified candidates to our network of more than 200 global partners, and is now emerging as one of Southeast Asia’s best recruitment companies.We have established unmatched recruitment services for both candidates and clients through our highly-processed recruitment strategies that assure unparalleled delivery of excellent service in people management.For business inquiries, send a message to BDG@nezdaglobal.com.

Job description

Nezda is currently looking for Utilization Review Nurse (USRN) – WFH candidates.

Qualifications:
Active USRN and PHRN License
With at least 1 Year Clinical or Hospital Experience

Job Description:
Reviews service requests to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits and contracts.
Responsible for conducting medical management review activities which require the review of clinical information against client specific criteria as noted above but excludes denial determinations.
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.