Job Description
Our US-based client, a premier multiline claims services provider, is looking for USRNs to be part of their team at their Philippine-based site.
The role will provide utilization management services for clients, insurers, and injured employees to promote quality medical care in a prompt, cost-effective manner.
Primary Duties and Responsibilities: Facilitate verbal and written communication with employees, employers, providers of care, and adjusters.
Gather medical data to evaluate the necessity of medical treatment and functional capabilities.
Insure timely processing of billings, utilization issues, and/or referral decisions.
Resolve, negotiate, and make recommendations regarding medical care.
Compare medical information to establish criteria (medical standards) and determine appropriateness of treatment and length of treatment.
Determine appropriateness of referrals to peer advisors.
Maintain and monit...