bgc - usrn with um appeals and grievance Nurse experienceShearwater Health Advisors Inc.

USRN with UM APPEALS AND GRIEVANCE NURSE EXPERIENCE
 
JOB SUMMARY:
Performs Quality of Care Clinical Reviews under the Program’s Quality Improvement Team.
Provide timely and accurate reporting/data
and other reporting on an, as-needed basis.
Ensures proper processing and submission with appropriate clinical information
Collaborative and has background on client /stakeholder management
Responsible for monitoring performance and to identify improvement opportunities
Handles and Processes Recommendations, Policies & Procedures, Workflows, and SOPs
Operational area audit support and assists reviewing of cases concerning the Quality of Care received by members
Recommend process efficiencies, strategies for improvement and/or solutions to align
with business strategies.
Will serve as Clinical SME for CMS regulations and assists small to intermediate cross-functional projects, influencing organizational change related to business processes
Participates in clinical process improvement meetings and/or discussions and provides strategies for improvement.
QUALIFICATIONS:
Must have an ACTIVE USRN License
with experience in QA/SME/Training/Internal Audit Background under Utilization Management
Knowledge on CMS regulations and Audit
Good comms skills and analytical skills
MUST have a UM Appeals and Grievance auditing experience
 
 
Why #JoinTheTribe
 
COMPENSATION AND BENEFITS
Competitive Compensation and Benefits Package
Non-taxable & Taxable Allowances
Certification / License based allowance
Pay for Performance Program
HMO Coverage on Day 1
Group Life Insurance
CAREER GROWTH
Medical Coding Academy
American Dream Program
Learning & Development Program e.g. skills / role based trainings, Leadership program, etc.
WORK LIFE EFFECTIVENESS
Fun Engagement Activities
Rewards and Recognition
Maximum of 24 days Service Incentive Leaves for first complete year
 
TO KNOW MORE ABOUT US!
Please go to https://swhealth.com/jointhetribe and fill-up necessary information.
FACEBOOK: Shearwater Health – Philippines
INSTAGRAM: @shearwatertribe
YOUTUBE: Shearwater Health
 

2 to 4 Years Experience