USRN / Onsite Pasig / Competitive Salary

About the Role:
The Case Manager Nurse will work closely with physicians, clinical staff, and various departments. This includes engaging with insurance providers, patients and their families, legal representatives, and other healthcare institutions. The role also requires collaboration with nursing teams, billing, medical social workers, and more.

Primary Responsibilities:

- Manage cases including prior authorizations for drugs and procedures based on hospital protocols
- Coordinate and oversee all case management-related activities
- Ensure compliance with HIPAA regulations when handling patient information
- Support tasks such as outpatient service authorizations, writing denial letters, and related duties

Qualifications:
- BS Nursing Graduate
- Active USRN License (Required)
- At least 2 years hospital nursing or case management experience in a US-based clinical setting (Required)
- 2 years hospital experience preferred
- Strong communication skills – verbal and written
- Ability to explain complex medical information to physicians and patients clearly
- High professional integrity, particularly in handling sensitive patient data
- Familiarity with payer systems, utilization review, insurance terms, InterQual and Milliman guidelines (preferred)
- Proficiency with healthcare software
- Skilled in appeals writing and clinical coordination