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USRN Voice Analyst

Job Location: Cebu

Job Number: 1937


- Job description

• Responsible for collaboration with healthcare providers and members to promote quality member outcome, to optimize member benefits, and to promote effective use of resources.
• Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources.
• Works with medical directors in interpreting appropriateness of care.
-US Registered Nurse with an active/inactive US State license (NCLEX passers are also welcome) -At least 3 months formal clinical experience -Experience in Case Management in the health industry a plus -Willing to work on shifting schedule

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