PHRN NURSES | UTILIZATION MANAGEMENT jobs in ORTIGAS CENTER PASIG CITY, United Kingdom

. Graduate of BS Nursing Must be a PH Registered Nurse with active license 2 years in utilization management, clinical appeals...Conducts comprehensive reviews of utilization data, including claims, authorizations, and medical records, to analyze...

Overview: The clinical quality program team is a group of RNs who helps increase health care access, appropriate utilization... with a program to address all the members care gaps. Primary Responsibilities: Case management Follow up calls with Members...

and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring... and evaluating). This includes case management, coordination of care, and medical management consulting. Function may...