Job Description

• Responsible in collaborating with healthcare providers and members to promote quality member outcomes, to optimize members’ 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 may steer members to appropriate providers, programs or community resources
• Work with medical directors in interpreting appropriateness of care

• BS Nursing (BSN) Degree
• Active US State License holder
• A minimum of three (3) months’ of prior working experience as a Registered Nurse in a clinical setting required
• Three months is equivalent to 480 hours of working experience as an RN
• Working experience as a Registered Nurse means holding an active RN license and providing direct patient care
• Clinical setting includes inpatient hospital, outpatient hospital or clinic
• Preferably (not a requirement, just an advantage) with 1 year of customer service or call-center experience and minimum of work experience

• Work in the Philippines, be with your family while earning good income!
• Healthcare Insurance (HMO) & Life Insurance coverage from day 1 of employment
• Expanded maternity leave up to 120 days*
• Flexible Working Arrangements
• Employee Stock Purchase Plan
• Healthy and Encouraging Work Environment
• Allowances
• Loyalty, Christmas Gift, Inclusion and Diversity Benefits
• Night Differential
• Retirement Plan