Utilization Review Nurse

Dynamic Talent Solutions View all jobs

  • Taguig City, Metro Manila
  • Permanent
  • Full-time
  • 1 month ago
The Reviewer is responsible for assessing the delivery of medical services to determine if the care provided is appropriate, medically necessary, and of high quality. This includes examination of documents to see if patients are given care consistent with their needs as well as inputting of approved Guidelines and References. The review typically involves medical records abstracting, analysis and documentation based on client-specific guidelines and templates.
  • Coordinates with the Production Supervisor and other Reviewers with regard to job assignment.
  • Evaluates completeness of submitted documents and identifies missing information that may support completion of utilization review request.
  • Constructs clear and accurate reviews of records that conform to the guidelines of each Client and determine if the care provided is appropriate, medically necessary, and of high quality.
  • Applies ACOEM Guidelines and evidence-based references to certify or elevate to peer review requested procedures. Submits reviews for edit within a specified period.
  • Meets a target production output or quota and a quality standard to be set by Management.

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