MetHealth USRN - InterQual Account

MetHealth

Urgent

RM3-6K[Monthly]

Hybrid - Cebu1-3 Yrs ExpBachelorFull-time

Employee Recognition and Rewards
Performance Bonus, Anniversary Gifts, Employee of the Month Award, Employee Recognition Program, Holiday Gifts
Government Mandated Benefits
13th Month Pay, Employee Loan, Pag-Ibig Fund, Paid Holidays, Philhealth, SSS/GSIS
Insurance Health & Wellness
Health Insurance, Life Insurance, HMO
Professional Development
Employee Assistance Program, Professional Development, Scholarship Program

Health Insurance Education & Support: Assist patients with understanding insurance coverage, claims results, and care navigation across complex medical conditions and multi-provider coordination.
Leadership & Mentorship: Act as a clinical resource for less experienced team members, provide coaching and feedback, and support professional development within the team.
Complex Problem Solving & Analysis: Solve moderately to highly complex problems by interpreting clinical data, identifying trends, and offering actionable solutions with minimal supervision.
Research & Evidence-Based Review: Conduct non-clinical research to support benefit determinations and ensure that final decisions are grounded in the latest clinical evidence and standards.
Documentation & Reporting Excellence: Maintain high standards of accuracy and timeliness in clinical review documentation, ensuring all decisions are well-supported and communicated to stakeholders.
Temporary Work-From-Home Setup

Must have At least 2 Years Hospital Experience
2 years Healthcare BPO Experience (As Utilization Management or Clinical Denial and Appeals)
Active USRN License
Must have knowledgeable with Interqual Or MCG Guidelines System
Must Be Amenable To Work On-Site For The First 2 Weeks To Get The Assets or Equipment