Utilization Reviewer Nurse
- Full Time
- National Capital Reg- Makati city
- PHP 13000 - 13000 /Monthly
Work Address : 17th Flr. Tower 2 RCBC Plaza, Ayala Avenue, Makati City
- Coordinates with the Production Supervisor and other Reviewers with regard to job assignment.
- Evaluates completeness of source documents and identifies missing record or information that may support completion of utilization review report.
- Constructs clear and accurate utilization review reports that conform to the guidelines of each Client, as well as to approved Guidelines and References including the State Treatment Guidelines, California Medical Treatment Utilization Schedule (MTUS), American College of Occupational and Environmental Medicine (ACOEM) Practice Guidelines, Official Disability Guidelines (ODG), and other evidence-based medicine. Also
- Prepares impairment determination and/or impairment determination review according to Client guidelines. This includes analyzing the medical history in order to come up with impairment / disability ratings that comply with the reporting requirements and conform to the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Permanent Disability Rating Schedule (PDRS), and Disability Evaluation under Social Security, as well as other state-mandated permanent impairment rating schedule.
- Submits utilization review reports within the specified timeframe in order to meet set turn-around time.
- Meets the target production output or quota and quality standard set by Management.
- Performs additional functions, as necessary.
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REQUIREMENTS: -Must be a graduate of Computer Studies/Computer Engineering/Information Technology/Electronics Engineering or equivalent -Have at least 1-2 years working experience in a SOC Operations environment. -At least 1 significant certification -Basic understanding and knowledge of any of the following areas (systems, network, security, and cloud).
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