Deskripsi Pekerjaan
Are you a US-licensed Registered Nurse looking to transition into a corporate clinical role while maintaining your professional credentials? Shearwater Health is seeking a detail-oriented US Registered Nurse to join our dynamic team in Metro Manila. In this specialized role, you will bridge the gap between clinical practice and administrative excellence by analyzing complex medical records.
As a key member of our clinical review team, you will be responsible for interpreting medical data, applying clinical guidelines, and drafting medical necessity determinations. This is an exceptional opportunity to leverage your bedside experience in a sophisticated, office-based environment that prioritizes evidence-based practice and healthcare quality. If you are passionate about medical coding, utilization review, and ensuring patients receive the appropriate level of care, we want to hear from you.
Tanggung Jawab
- Review and analyze clinical medical records to evaluate the appropriateness of care.
- Apply evidence-based clinical guidelines and insurance criteria to patient cases.
- Draft accurate and concise medical necessity determinations based on clinical findings.
- Summarize complex medical histories into actionable reports for stakeholders.
- Collaborate with cross-functional teams to ensure adherence to regulatory standards.
- Maintain high levels of accuracy and compliance in all clinical documentation.
- Participate in ongoing training to stay updated on US healthcare trends and protocols.
Kualifikasi
- Active and unrestricted US Registered Nurse (RN) license.
- Minimum of 2 years of clinical bedside experience in a hospital setting.
- Strong analytical and critical thinking skills with attention to detail.
- Excellent command of written and spoken English.
- Proficiency in electronic medical record (EMR) systems and Microsoft Office.
- Ability to interpret medical terminology and insurance coverage policies.
- Commitment to maintaining patient confidentiality and HIPAA compliance.
- Residing in or willing to work in Metro Manila.