Job Description
Access Healthcare Services Manila, Inc.
On-site - Pasay 1-3 Yrs Exp Bachelor Full-time
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Job Description
We are seeking a highly skilled and detail-orientedPH Registered Nurse (PHRN) to join our team.
The ideal candidate will have hands-on experience withInterQual ,MCG ,NCD , andLCD Guidelines
Key Responsibilities
- Conduct clinical reviews of inpatient and outpatient services using InterQual, MCG, NCD, and LCD criteria.
- Analyze patient records to determine the medical necessity and appropriateness of services.
- Collaborate with medical directors and multidisciplinary teams to review complex cases.
- Ensure compliance with regulatory and payer-specific guidelines.
- Document and maintain accurate and comprehensive review records.
- Participate in quality improvement and audit initiatives.
Qualifications
- Active PHR...