ISTA Solutions, an outsourcing/offshoring company, is in search of an experienced PHRN or Registered Nurse Utilization Review to join our rapidly expanding team. As a member of our team, you will have the opportunity to work with highly skilled professionals, who prioritize employee satisfaction and work-life balance. At ISTA Solutions, we pride ourselves on creating a culture focused on long-term success and life-long learning. We're looking for a team player who is ready to contribute to our mission, just like you!
The Utilization Review Specialist plays a critical role in assessing the utilization of healthcare services to ensure quality care while managing costs. They are responsible for reviewing medical records, treatment plans, and services provided to patients to determine if they meet established guidelines, medical necessity, and standards of care. This role collaborates with healthcare providers, insurance companies, and other stakeholders to optimize patient care and manage healthcare costs.
- will be handling cases from beginning to end
- will see which authorizations are about to expire and they will review the chart, determine their next eligibility, complete that review with the insurance company
- will have to communicate with other departments to gather information that might be missing or incomplete.
Qualifications:
- Current and valid PHRN license
- Excellent attention to detail and analytical skills.
- Effective communication and interpersonal abilities.
- Ability to work independently and collaboratively in a team-oriented environment.
- Experience with utilization review and management even if from the insurance perspective is helpful
- can do high level work
- Establishing relationships with the insurance companies and having that personality is important
- Willing to work on a shifting schedule
- Must be residing in Greater Manila Area Only
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
- Stong 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
