Deskripsi Pekerjaan
Are you a compassionate and skilled nurse looking to make a tangible impact on the US healthcare system from the Philippines? Join Transworld Systems Customer Services as a Utilization Nurse and take the next step in your professional career. In this dynamic BPO setting, you will serve as a critical link in the healthcare continuum, providing essential clinical support to US clients. You will be responsible for ensuring that patients receive the highest standard of care through rigorous utilization management and expert clinical review.
As a Utilization Nurse, your expertise will directly influence patient outcomes and cost-effective care delivery. You will work in a collaborative environment that values professional growth, offering you the opportunity to hone your skills in utilization review, case management, and care coordination. If you possess a keen eye for detail, strong clinical judgment, and a desire to work in a global healthcare setting, this is the perfect opportunity for you to excel and grow.
Tanggung Jawab
- Conduct comprehensive utilization management reviews for US healthcare clients to ensure medical necessity and appropriate care delivery.
- Perform detailed clinical assessments by reviewing medical records, physician orders, and patient histories.
- Coordinate care plans and communicate findings effectively with healthcare providers, payers, and patients.
- Ensure strict compliance with US healthcare regulations, company policies, and industry standards.
- Document clinical determinations accurately and timely within the electronic health record (EHR) system.
- Support the appeals and grievance processes by providing expert clinical testimony and documentation.
- Collaborate with interdisciplinary teams to optimize patient care pathways and resolve complex clinical issues.
Kualifikasi
- Bachelor of Science in Nursing (BSN) degree required; valid and active RN license is mandatory.
- Minimum of 1-3 years of clinical nursing experience, preferably in acute care, critical care, or utilization review.
- Strong understanding of medical terminology, anatomy, physiology, and pharmacology.
- Excellent written and verbal communication skills with the ability to explain complex clinical concepts clearly.
- Proficiency in using electronic health records (EHR) and computer systems.
- Ability to work independently in a remote or BPO setting while meeting strict deadlines.
- Detail-oriented approach with high accuracy in data entry and analysis.