Compensation Utilization Management (WCUM) program staff such as the WCUM Intake Representatives, WCUM Nurse Reviewers, WCUM Intake SMEs, WCUM Nurse SMEs, WCUM Nurse Trainer with the aim of meeting objectives set by the Manager, Operations Director and / or VP for Client Services to ensure that our contractual service metrics are met consistently. Qualifications :
Must have a Bachelor’s Degree in Nursing with an active and unrestricted license in Philippines and US (Mainland State)
Preferably with 1 year clinical bedside experience.
Has background in Workers Compensation Utilization Management reviews (Prospective / Concurrent / Retrospective) for Inpatient / Outpatient services according to the URAC standards and client requirements and / or policies.
Has background in Healthcare Utilization Management Provider Appeals reviews (Prospective / Concurrent / Retrospective) for Inpatient / Outpatient services according to the URAC standards and client requirements and / or policies.
Must be amenable to work in McKinley Hills, Taguig City or Bridgetowne, Quezon City
Willingness to work on shifting schedule.
Open to SME's with team management and people management background.
Job Location : Pasig City, National Capital Region, Philippines Taguig, Metro Manila, Philippines