Crawford & Co.

GBSC-Clinical Program Nurse III

Job Locations PH-Manila
Posted Date 5 months ago(16/9/2022 9:07 AM)
Requisition ID
2022-20154
# of Openings
1
Category
Medical Case Management

Summary

Responsible for providing proactive case management services by assessing existing medical records.

Job Scope

A. Case Management Services

  • Analyzes and reviews case records, evaluates client’s medical status, and defines their needs and problems
  • Provides opinions regarding case costs, treatment plan, outcome and problem areas, and makes recommendation to facilitate rehabilitation goals and return to work
  • Utilizes experience and medical resources to interpret medical records and test results, and provide appropriate assessments accordingly
  • Reviews cases with immediate superior monthly to evaluate files and obtain directions
  • Performs job site evaluations/summaries to facilitate case management process

 

B. Client Relations

  • Establishes professional working relationship with internal and external clients by timely return to work
  • Maintains contact with all parties involved on case to appraise them of case activity, case direction, or receive authorization for services

C. Business Process Support

  • Performs peer reviews and independent medical examination
  • Meets monthly production and quality assessment (QA) requirements
  • Deals with problem resolution independently by using appropriate research and resources
  • Refers matters beyond limits of authority and expertise to immediate superior for direction
  • Upholds the Crawford Code of Conduct by protecting the confidentiality of information
  • Performs other related tasks as required or needed

Functional Knowledge

  • Minimum of two (2) years diverse clinical experience or prior experience in Medical Bill Review.
  • Bachelor’s degree in Nursing.
  • Must be a Philippine Registered Nurse; has an active US Registered Nurse license from New York if required by the process.
  • Excellent verbal communication skills and customer orientation
  • Proficient in word processing software applications
  • Analytical skills - Ability to perform basic and complex bill review according to standard operating procedures (SOP)
  • Ability to deliver excellent customer service
  • Active listening and phone handling skills
  • Critical thinking skills - Ability to make judgements and recommendations
  • Maintains high degree of professionalism and confidentiality
  • Ability to multi-task, prioritize and manage time effectively
  • Interpersonal skills - Able to work independently and as a team member
  • Keen attention to details

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