Position Title:Medical Management Specialist I/ PHRN Shift: Job Description: Responsible for providing non-clinical support to the Medical Management and/or Operations areas. Primary duties may include, but are not limited to: Gathers clinical information regarding case and
MediCard Phils., Inc. is one of the countrys leading HMO and the only HMO founded and run by Doctors. Since its inception, the concept of service-oriented total health care has been the molding ideal of MediCard.
Company Description About Sutherland Artificial Intelligence. Automation. Cloud engineering. Advanced analytics. For business leaders, these are key factors of success. For us, they’re our core expertise. We work with iconic brands worldwide. We bring them a
Performs training and provides subject matter expertise on clinical reviews needed to resolve and process appeals to team members. • Reviews medical records and clinical data to determine medical necessity for services in accordance with policies,
We are looking for a USRN Utilization Review Specialist responsible for reviewing clinical information, medical records, and patient cases to determine the medical necessity, appropriateness, and level of care based on established clinical guidelines and payer requirements.
About the role: The Utilization Management (UM) PHRN is responsible for the review, processing, and resolution of UM cases. The role ensures timely and clinically sound UM review, upholding member rights and health plan obligations under commercial
The Clinical Consultant provides clinical and operational support as a U.S. Healthcare Subject Matter Expert, providing various clinical support services and operational guidance for business processes, to include Case Management, Utilization Management, Clinical Coverage Preservice, Claims and
Work setup: ONSITE / BGC, Taguig within 6 months then transfer to Bridgetowne, QC Work schedule: Nightshift The Team Lead – Clinical Denials provides operational and clinical leadership to a team of Clinical Denials Specialists supporting
Work setup: ONSITE / BGC, Taguig within 6 months then transfer to Bridgetowne, QC Work schedule: Nightshift The QA – Clinical Denials is responsible for conducting quality audits of clinical denial reviews, appeal preparation, documentation, coding
Work setup: ONSITE / BGC, Taguig within 6 months then transfer to Bridgetowne, QC Work schedule: Nightshift The QA Team Lead – Clinical Denials provides day-to-day leadership and oversight for the quality assurance function supporting Clinical
Work setup: ONSITE / BGC, Taguig within 6 months then transfer to Bridgetowne, QC Work schedule: Nightshift The Program Manager – Clinical Denials provides strategic and operational leadership for one or more clinical denials programs across
Performs training and provides subject matter expertise on clinical reviews needed to resolve and process appeals to team members. • Reviews medical records and clinical data to determine medical necessity for services in accordance
Work ScheduleStandard (Mon-Fri) Environmental ConditionsOffice Job Description Join Us as a Lead Medical Project Coordinator At Thermo Fisher Scientific, you’ll discover meaningful work that makes a positive impact on a global scale. Join our colleagues in
The Opportunity This is not a traditional nursing management role. As Manager – Clinical Nursing , you will lead the delivery of high-quality, compassionate, and patient-centered care across inpatient nursing units while ensuring operational excellence, staff
WHY JOIN US? The Company Nurse (Occupational Health Nurse) is responsible for promoting and maintaining the health, safety, and well-being of employees by delivering quality occupational health services, administering first aid and emergency care, managing the