Deskripsi Pekerjaan
Are you an experienced US Registered Nurse looking to leverage your clinical expertise in a dynamic, corporate healthcare environment? Omega Healthcare Management Services Inc. is seeking a detail-oriented USRN Reviewer to join our growing team in Metro Manila. In this role, you will play a critical part in ensuring the highest standards of care and compliance by performing rigorous clinical reviews based on established guidelines.
As a USRN Reviewer, you will bridge the gap between clinical practice and administrative excellence. You will utilize your knowledge of InterQual or MCG criteria to evaluate medical necessity, ensure schedule adherence, and maintain optimal quality and productivity standards. We offer a supportive environment that values your professional background and provides opportunities for continuous growth in the healthcare management industry.
Tanggung Jawab
- Conduct thorough medical necessity reviews using InterQual and/or MCG evidence-based clinical criteria.
- Monitor and evaluate nursing activities to ensure strict adherence to established schedules and protocols.
- Assess the accuracy, quality, and timeliness of clinical documentation to ensure compliance with healthcare standards.
- Maintain high productivity levels while meeting daily turn-around time targets for clinical audits and reviews.
- Collaborate with cross-functional teams to address discrepancies and improve overall service delivery.
- Prepare detailed reports regarding audit findings and performance metrics.
- Stay updated with the latest clinical guidelines and regulatory changes affecting healthcare utilization management.
Kualifikasi
- Must be an active, licensed US Registered Nurse (USRN).
- Proven experience in utilization review, clinical auditing, or case management.
- In-depth knowledge and hands-on experience applying InterQual or MCG clinical decision support tools.
- Strong analytical skills with a keen eye for detail and data accuracy.
- Excellent verbal and written communication skills for professional reporting.
- Ability to thrive in a fast-paced environment while maintaining high quality and accuracy standards.
- Willingness to work in a full-time capacity in Metro Manila.