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Keywords / Skills : CLINICAL EXPERIENCE

2 - 5 years
Posted: 2019-02-20

Nationality
Philippines
Industry
Hospitals/Healthcare/Diagnostics
Medical Transcription
Function
Health Care
Role
Nurse
Medical Coder
Other Health Care/ Hospitals
Education
Bachelors
Degree
Posted On
20th Feb 2019
Job Description
  • Collaborates with team members and functional heads to obtain deliverable based on agreed targets/objectives.
  • Maintains levels of performance including but not limited to attendance, adherence to protocols, customer courtesy, and all other productivity and efficiency targets and objectives.
  • Ensures confidentiality of all information, policies, and procedures as required by the Health Insurance Portability and Accountability Act (HIPAA) protocols.
  • Performs Utilization Management (UM) reviews in accordance with U.S. State/Federal and other mandated regulations. Maintains compliance with regulatory changes affecting UM.
  • Performs UM reviews (prospective/concurrent/retrospective) for inpatient and outpatient services according to the prescribed standards and client requirements / policies.
  • Reviews UM requests for services against established clinical review criteria, referring cases not meeting criteria to a physician reviewer or prescribed escalation protocol.
  • Adheres to Department of Labor, State, and company UM timeframe requirements.
  • Delivers communication of information (potential concerns/threats, client feedback, etc.) to immediate superior for proper escalation / resolution.
  • Processes customer calls consistent with program specified strategies and customer satisfaction measurements.
  • Generates reports as required to participate in the review, preparation, and submission of operations-related reports.
JOB REQUIREMENTS:
  • Must be a Philippine Registered Nurse (PHRN), and a US Registered Nurse (USRN)
  • At least 2-5 years of work experience in clinical BPO experience in any of or similar domains of Utilization Management, Case Management, Disease Management, Wellness, Medical Coding and Billing, Pharmacy Benefits Management in any of the U.S. industry sectors of Workers’ Compensation; Commercial Managed Care; Health, Disability, Life, Property and Casualty Insurance; Accountable Care Organizations (ACO’s) or any other sector wherein the work performed is related to the use of clinical knowledge and skills.
  • Must be willing to work in Alabang, Muntinlupa
  • Must be willing to work in shifting schedule.

Key Skill(s)

About Company

ADEC Innovations is a global leader in Environmental, Social, and Governance (ESG) solutions, providing consulting, technology, outsourcing and professional services. ADEC Innovations fully integrates industry expertise with the power of technology, scalable data processes, and business management services to deliver custom-tailored solutions that address our partners’ unique business requirements. Our presence spans five continents— Africa, Asia, Australia, Europe, and North America—as we help our partners improve operational efficiencies and optimize their sustainable use of resources while ensuring long-term financial viability.

Our company has over 5,500 employees globally—and we are looking to employ more! As a global organization that covers multiple business areas, we employ business process associates, programmers, web and software developers, online trainers and educators, and other industry professionals.
We provide unlimited opportunities for skills development and career advancement as we immerse our employees in world-class employment experiences within a pleasant but dynamic work environment. With career compensation above the industry average, we hone our people to become our country’s next managers and industry experts.

At ADEC Innovations, every piece of work is expected to have the stamp of quality and excellence, which is why we train our employees to embody these values. We empower them to perform with passion and commitment, helping them to keep advancing to the next level as they consistently exceed every client expectation.

Put your talents to real use and take ownership of the kind of career that you deserve. Send us your CV and contact us now!
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