Clinical Program Nurse III – Case Management

About the role

We are seeking a Clinical Program Nurse III to provide proactive case management services, reviewing medical records and coordinating rehabilitation plans to support clients’ return to work.

Key responsibilities

• Analyze and review case records, evaluate medical status, and identify client needs and problems.
• Provide opinions on case costs, treatment plans, outcomes, and recommend rehabilitation goals.
• Interpret medical records and test results using clinical expertise and medical resources.
• Conduct monthly case reviews with supervisors and perform job‑site evaluations to facilitate case management.
• Maintain professional relationships with internal and external clients, keeping all parties informed of case activity and obtaining service authorizations.
• Perform peer reviews, independent medical examinations, and meet monthly production and quality‑assessment targets.
• Resolve problems independently, refer complex matters to supervisors, and uphold confidentiality standards.

Required profile

• Bachelor’s degree in Nursing.
• Active, unrestricted RN license in the Philippines and a U.S. state.
• Minimum two years of diverse clinical experience or medical bill review experience.
• Excellent verbal communication, customer orientation, and professional conduct.
• Strong analytical, critical‑thinking, and multitasking abilities.
• High attention to detail and ability to work both independently and as part of a team.

Required skills

• Proficiency with word‑processing software applications.
• Ability to perform basic and complex medical bill review according to standard operating procedures.