Found Description
Job Type: Full-Time (Hybrid: 3x onsite / 2x WFH)
Location: Ayala, Makati
Schedule: Morning Shift
About the Role
This role is responsible for evaluating medical records, performing clinical documentation reviews , handling pre-authorization requests , coordinating with payers, and ensuring compliance with healthcare guidelines and quality standards.
The ideal candidate has strong experience in utilization review, case management, or prior authorization , with a deep understanding of U.S. healthcare processes.
Key Responsibilities
Quality Assurance & Chart Review
- Conduct medical record reviews to identify documentation gaps, risk areas, and compliance issues
- Perform internal quality assurance audits on nursing documentation
- Identify potential survey risks and regulatory violations
- Review MDS-related documentation for accuracy and com...
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