Opportunity 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 monitor ...