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USRN Clinical Associate

Company Name Confidential

Keywords / Skills : Nurses, Registered Nurse, Nursing, Staff Nurse, Hospital, Health Care, Nurse,

1 - 11 years
Posted: 2019-09-20

Nationality
Philippines
Industry
ITES/BPO
Hospitals/Healthcare/Diagnostics
Function
Customer Service/Call Centre/BPO
Health Care
Role
Customer Service Executive
Nurse
Education
Bachelors
Degree
Posted On
20th Sep 2019
Job Description
Responsibilities:
  • Conducts pre-certification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
  • Ensures member access to medical necessary, quality healthcare in a cost effective setting according to contract.
  • Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process.
  • Collaborates with providers to assess members’ needs for early identification of and proactive planning for discharge planning.
  • Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications.
  • Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.
Qualifications:
  • Must be an NCLEX Passer with active US Mainland Board of Nursing License
  • Requires current active unrestricted USRN license to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States
  • At least 1 year cumulative experience in any (or combination) of the ff: clinical bedside experience in a hospital / clinical / occupational health setting and bpo experience in a healthcare information management account
  • Utilization Management or Prior Authorization Clinical Experience is an advantage, but not required
  • Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills
  • Willing to work at Bonifacio Global City, Taguig in shifting schedules


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