We are hiring for US RN (New Jersey licensed only), Non-Voice support in BGC, Taguig city.

This is a Temporary work from home following a shifting work schedule.

Salary is up to 55k (open for negotiation).

Requirements:

• Must have USRN
• Must have RN New Jersey licensed.
• At least 6 months to 1 year bedside experience.
• Willing to work on shifting work schedule.

Duties & Responsibilities:

• Facilitate verbal and written communication with employees, employers, providers of care, and adjusters.
• Gather medical data to evaluate the necessity of medical treatment and functional capabilities.
• Insure timely processing of billings, utilization issues, and/or referral decisions.
• Resolve, negotiate, and make recommendations regarding medical care.
• Compare medical information to establish criteria (medical standards) and determine appropriateness of treatment and length of treatment.
• Determine appropriateness of referrals to peer advisors.
• Maintain and monitor volume and cost of peer advisor reviews for management report.
• Perform and maintain research, documentation, statistics, and auditing information on all types of medical providers, procedures, scopes of practice, and professional organizations.
• Respond promptly and expertly to telephone inquiries, verbal or written communications from providers, UM department staff, and others.
• Function as a resource to medical audit, other UM department staff, customers, and outside agencies.
• Assist claims professional in compensability issues involving ICD-10 codes, medical service providers, treatment parameters, dates of service, etc.
• Provide appropriate, adequate, and timely reports to management, accurately reflecting activities and results.
• Review application for patient admission and approve admission or refer case to peer advisor for review and course of action when case fails to meet admission standards.
• Attend training/educational classes as appropriate.
• Coordinate activities of staff in supervisor's absence, where applicable.
• Must actively participate in QM monitoring and strive to achieve departmental standards and objectives.
• Perform other duties and responsibilities as deemed necessary and assigned.

Start date: August