clinical AnalystMedRisk Philippines

The primary role of the Clinical Analyst position is to assist in the Clinical Case Prep associated with the Clinical Review process and the administrative tasks associated with the Teleservices program. When involved with Clinical Review, the Analyst will perform a review of services requested, collect non-clinical data and perform scripted clinical screening that does not require evaluation or interpretation of clinical information. When assisting in Teleservices, the Analyst will be involved with activities to allow for the injured worker to move through the program from scheduling for the initial visit through discharge from services.
DUTIES AND RESPONSIBILITIES
Clinical Review:
Reviews all assigned cases to provide efficient, cost-effective and quality utilization review services.
Initiates review for requested service upon system referral (or referral from non-clinical staff)
Review types include Continued Authorization (provide documented recommendations to adjusters and Nurse Case Managers based on use of appropriate guidelines.) and Internal Clinical Reviews
Obtains (from providers), compiles, proofs and processes information received from providers/adjusters to aid in the final determination of a clinical reviewer.
Reviews initial evaluation and all clinical documentation against relevant treatment guidelines.
Teleservices:
Opens new Telerehab cases in the system and participates in scheduling injured workers for Telerehab
Manages phone calls coming into department through the Telerehab Queue (internal and external calls)
Monitors and handles Telerehab inbox including email, voicemail and fax communications for Teleservices team
Participates in processing continued authorization for Telerehab cases including communication with physician offices and adjusters
Handles other Teleservices duties as assigned
Overall Duties:
Documents all pertinent clinical patient/case information and actions into the case notes.
Complies with all established policies and procedures
Assists manager and team in quality improvement projects to provide instructive feedback to practitioners within scope
Attends meetings and trainings.
Meets quality management standards.
Performs activities within the scope of professional licensure.
Completes other duties and projects as assigned.
QUALIFICATIONS
Must hold a current Philippines Physical Therapy License
Experience: 2-3 years of outpatient hospital clinic setting preferred
Knowledgeable of current physical medicine treatments
Excellent verbal and written communication skills
Organizational skills, prioritization, problem-solving and decision making skills are required
Ability to multi-task in a fast paced environment
Must be computer literate and be able to use the keyboard accurately. Experience with Microsoft Office and Zoom app are desired.
Strong analytical and interpersonal skills are also required.
Not required, but desired: current US Physical Therapy license and/or Doctor of Physical Therapy degree
Experience in utilization review, case management, quality improvement and/or managed care is desired
Willing to work on-site in Mandaluyong City
Preferably residing within Metro Manila only. Candidates in Cavite, Rizal, and Bulacan area are welcome to apply as long as they are amenable to report onsite in Rockwell Business Center Sheridan - South Tower, Sheridan St., Mandaluyong City
MedRisk Philippines

Mandaluyong City, Metro Manila
Permanent
Full-time