Utilization Reviewer L-CM

ISTA Solutions is currently looking for experienced PHRN who have previous experience dealing with US Healthcare Insurance accounts, particularly in Utilization Management. This position entails semi-back-office work dealing with US-based Clients related to Claims, Benefits, Eligibility, Appeals, Prior Authorization, and particularly in Utilization Review.

This position is for a Work on-site set-up, selected candidates must be willing to report in Makati.

Job Description:

• Process information based on standard operating procedures,
• Adhere to the client's process for data delivery and correspondence.
• Coordinate with respective personnel through calls, emails, etc.

Requirements

• At least 2 years experience as an Utilization Reviewer / Clinical Nurse Reviewer for a US Healthcare account
• Must have an active PHRN license (USRN license is a PLUS)
• Must have Dialysis Training Certification
• Good working knowledge with Clinical Appeals and Revenue Cycle Management
• Excellent verbal and written English skills
• Willing to work onsite in MAKATI
• Amenable working night shifts

Benefits

What can we offer you?

• Competitive salary and benefits
• Health Insurance with free dependents*
• 10%-night differential
• Attendance Bonus
• Paid time off
• Convertible to cash leave credits
• Performance Appraisal
• Work-life balance
• A focus on growing your career path with us
• We encourage you to follow your passions and learn new skills

Our commitment to you

• Strong culture and values-driven leadership
• We create opportunities for you to learn and grow at any stage of your career
• Continuous learning and innovation
• We foster an all inclusive environment where everyone thrives