USRN - Internal Care Manager

at  Manulife

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JOB DESCRIPTION

The USRN – Internal Care Manager is responsible for using clinical expertise to assess clinical information on low to moderate exposure claims consistent with current business protocols. The role is accountable for ensuring the accuracy of the clinical evidence to compare against policy or plan language in order to determine benefit eligibility on LTC claims. This role exists to ensure that only those policyholders meeting their policy’s criteria for eligibility remain approved.
Have the skills and knowledge for the job? Learn more about the opening below!

QUALIFICATIONS:

License: US Registered Nurses (NY license preferred but not required)
Education: Bachelor’s Degree in Nursing preferably specializing in geriatric or long term care and/or chronic illness fields
Experience: Clinical nursing or claims processing experience is an advantage
Location: Mactan Newtown in Cebu
Work Arrangement: HYBRID Work Arrangement – amenability and readiness to work onsite during training and from home anytime (dependent on business needs OR current external environment/situation).
Language: Excellent English skills

SKILLS AND COMPETENCIES:

• Adaptability – quick study; agile and flexible to any situation
• Analytical and Decision-Making skills – analyze cases and claims, identify if valid and provide recommendations.
• High level of Attention to details
• Ability to contact providers for clarification needed in order to determine benefits eligibility
• Fluency with MS Office and ability to learn new computer applications easily.

• Assess clinical needs to determine ongoing eligibility for long term care benefits
• Ongoing monitoring of claims for high-risk activity
• Make benefit eligibility determinations based on onsite/virtual assessments, functional/cognitive screening forms and/or other clinical evidence on ongoing claims
• Appropriately set clinical follow updates based on current protocols
• Complete trainings as assigned to maintain currency with protocol and guideline updates
• Collaborate with other business units as needed to provide optimum service to customers
• Participate in regular one-on-one meetings with management, attend staff meetings and attend other work activities as directed by manager
• Collaborate with senior care management staff on specific claim questions to ensure accurate decision-making