***LOOKING FOR FILIPINOS OR PHILIPPINES-BASED CANDIDATES***

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Position: Utilization Review Nurse (Full-time)
Salary: up to 1,400 USD/month
Working Hours: Monday - Friday, 12 pm to 8 pm EST (1am to 9am PH time)

About the Client:

Our client in the US is a company that specializes in independent medical reviews (IMRs). They offer a variety of services, including Independent medical reviews (IMRs), Peer reviews, Record reviews, Medico-legal consulting, and Regulatory compliance. They use a combination of state-licensed physicians and proprietary software to ensure that their reviews are accurate and consistent. They partner with insurers, health plans, TPAs, and state regulatory authorities.

Job Summary:

The Utilization Review Nurse performs an integral role in our utilization review process by performing record review/case summaries, selection and application of guidelines/literature, quality assurance of physician reviewer reports, and administrative support, including phone and email, for both clinical and non-clinical staff.

Essentials Duties and Responsibilities:

To perform this job successfully, the employee must be able to efficiently and effectively perform each of the following essential functions. Reasonable accommodation may be made for individuals with disabilities.

These duties include but are not limited to:

Perform all aspects of Utilization Review for Workers' Compensation and group health peer and independent reviews including record summarization and application/interpretation of literature/guidelines.
Serve as a liaison between physician reviewer staff and senior clinical leadership.
Quality Assurance of independent and peer reviews prior to client-side submission.
Assist the Case Analyst in times of high volume or coverage with administrative tasks such as phone or email support.
Language Skills: Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents. Ability to respond to common inquiries or complaints from customers, regulatory and governmental agencies, attorneys, or members of the business community. Ability to write letters, memos and reports that conform to prescribed style, format and grammatical correctness. Ability to effectively present information to top management, in claims and client settings. Strong written and verbal communication skills to effectively communicate with injured workers, medical professionals, employers, claims staff and others.
Math Skills: Ability to calculate percentages and statistics in compiling quality management reports. Ability to convert statistical information into appropriate graphs for data analysis.
Reasoning Skills: Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical and/or clinical instructions in mathematical or diagram form and deal with several abstract and concrete variables. Must have strong organizational, problem solving and time management skills. Sound professional judgement.

Requirements:

At least 2 years of experience as a Workers Compensation Utilization Review Nurse in a US setting is required
Must be a registered nurse in the Philippines; USRN licensed is a plus
Ability to research relevant literature
Proficiency with Microsoft Office programs
Strong oral and written communication skills
Strong statistical skills for compiling and presenting data
Understanding and ability to apply quality assurance concepts