- Philippine Registered Nurse
- Active USRN License (can now consider Non-Mainland License)
- At least 1 year hospital experience
- Up to 100k Sign on Bonus
Salary: 50,000 to 65,000
• Responsible for collaboration with healthcare providers and members to promote quality member outcome, to optimize member benefits, and to promote effective use of resources.
• 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 setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources.
• Works with medical directors in interpreting appropriateness of care.