Job Description & Requirements
Description:
1. Responsible to collaborate with healthcare providers and members to promote quality member outcome, to optimize member benefits, and to promote effective use of resources.
2. Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment settings by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care product, and may steer members to appropriate providers, programs or community resources.
3. Works with medical directors in interpreting appropriateness of care.

Requirements:
1. Graduate of BS Nursing or any equivalent course.
2. with at least 3 mos clinical or hospital experience.
3. holds an active and unrestricted US Registered Nurse license must be PHRN.
4. Excellent written and oral communication skills
5. BPO experience is a plus

How to Apply
Easy steps to apply: 1. Click the APPLY button below. 2. OR send CV/ resume to m.gemillan@vcc-link.com [subject: USRN- pinoy]