Medical Case Management Support

We’re seeking a compassionate and organized Registered Nurse to join our team as a Medical Case Management Support professional. In this crucial role, you’ll be at the forefront of managing the medical treatment for workers’ compensation injury cases, ensuring that patients receive comprehensive care.

Key Responsibilities:
• Conduct thorough searches for suitable physicians within the Medical Provider Network (MPN) for the effective treatment of work-related injuries.
• Facilitate and coordinate referrals to Field case management (FCM) and relevant vendors as needed for specialized services.
• Analyze and evaluate medical reports, ensuring accuracy and completeness. Provide detailed summaries and assessments for internal and external stakeholders.
• Review and assess work status reports to determine the impact on the patient’s ability to return to work, coordinating with healthcare providers as necessary.
• Examine diagnostic reports to understand the nature and extent of injuries, collaborating with medical professionals to formulate appropriate care plans.
• Evaluate requests for authorization for Utilization Review (UR) services and forward necessary documents to UR for processing.
• Maintain effective communication with physicians’ offices, ensuring timely completion of tasks and obtaining necessary information for case management.
• Prepare comprehensive summaries of medical reports and formulate action plans based on the assessment of each case.
• Manage and prioritize tasks efficiently, ensuring timely completion of all responsibilities associated with case management.

Qualifications:
• Active Registered Nurse (RN) license in the Philippines set by the Professional Regulation Commission (PRC).
• 2+ years of nursing experience in a hospital or clinic setting.
• Excellent comprehension, writing, and speaking in English, including medical terminology.
• Strong analytical skills with the ability to comprehensively review, assess, and summarize medical reports.
• Type 45+ WPM
• Extremely strong skills in organization, prioritizing, time management, recordkeeping, critical thinking, problem-solving, and professional judgment.
• Proficiency in Microsoft Office suite, use of the Internet, case management software, and various layperson-level software applications.
• Preferred experience in nurse case management, utilization review and management, healthcare administration, insurance claims, workers’ compensation, or related fields.

If interested, please provide a link to your resume for assessment.