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1,000 - 50,000 employees
Overview
Jobs & Opportunities
Employer Website
PHRN - Nurse Utilization and Clinical Advisor Services Analyst II
Mandaluyong City,
Nursing graduate with PH license, with at least 1-year BPO experience
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Opportunity details
Opportunity Type
Graduate Job
Number of Vacancies
1
Start Date
ASAP
Application dates
Applications Close
31 May 2021
Minimum requirements
Minimum Prior Qualification
Certificate
Accepting International Applications
No
Qualifications Accepted
M
Medical & Health Sciences
Nursing & Midwifery
Aged Care Nursing
Community Nursing
Critical Care Nursing
Family & Child Health Nursing
Mental Health Nursing
Midwifery
Nursing & Midwifery (all other)
Job Track Description:
Requires formal education and relevant expertise in a professional, sales, or technical area.
Performs technical-based activities.
Contributes to and manages projects.
Uses deductive reasoning to solve problems and make recommendations.
Interfaces with and influences key stakeholders.
Leverages previous knowledge and expertise to achieve results.
Ability to complete work self-guided.
College or university degree required.
General Profile
Requires an understanding of the company, processes, and customers.
Uses existing procedures to solve routine or standard problems.
Receives moderate guidance and direction from others.
Functional Knowledge
Requires expanded conceptual understanding of theories, practices, and procedures.
Business Expertise
Uses an understanding of key business drivers to accomplish work.
Impact
Impacts a team, by example, through the quality service and information provided
Works within guidelines and policies.
Leadership
No supervisory responsibilities.
Provides informal guidance to new team members.
Problem Solving
Uses existing procedures to solve standard problems.
Examines information and standard practices to make judgments.
Interpersonal Skills
Exchanges complex information and ideas effectively.
Responsibility Statements
Applies medical judgment to adjudication of cases/claims.
Reviews requests for denial reconsideration and appeals.
Manually price and review claims for appropriateness of care or coverage.
Works directly with the client to provide input under program policy or procedural requirements.
Coordinate with clinical peer reviewers for case/claim resolution.
Performs other duties as assigned.
Complies with all policies and standards.
Additional Information
Requires Registered Nurse license in good standing.
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