job description
Join eData Services Philippines Inc. as a Physician Utilization Reviewer and play a pivotal role in ensuring high-quality, cost-effective healthcare delivery. This remote position allows you to work from the vibrant locations of Bali, Indonesia, while contributing your medical expertise to review and assess patient care against established clinical criteria.
As a Utilization Reviewer, you will collaborate with healthcare providers, insurance companies, and internal teams to evaluate the medical necessity, appropriateness, and efficiency of treatments, procedures, and hospital stays. Your insights will directly impact patient outcomes and operational efficiency in the healthcare system.
This is a unique opportunity for licensed physicians to transition into a non-clinical, administrative role while maintaining a meaningful connection to patient care. Enjoy the flexibility of remote work in a tropical paradise, with a competitive salary and the chance to grow in the dynamic field of healthcare management.
Responsibility
- Conduct thorough medical necessity reviews for hospital admissions, procedures, and treatments based on clinical guidelines and insurance policies.
- Collaborate with healthcare providers, case managers, and insurance representatives to ensure compliance with utilization management protocols.
- Document and communicate detailed review findings in a clear, concise, and timely manner to stakeholders.
- Identify and recommend alternative care settings or treatments when appropriate to optimize patient outcomes and cost efficiency.
- Participate in peer reviews and quality assurance audits to maintain high standards of medical review accuracy.
- Stay updated on latest medical guidelines, insurance policies, and regulatory requirements affecting utilization review processes.
- Provide educational support and training to clinical staff on utilization management best practices.
- Utilize electronic health record (EHR) systems and proprietary software to track, analyze, and report on review activities.
Qualifications
- Medical Doctor (MD) or Doctor of Osteopathy (DO) degree from an accredited institution.
- Active, unrestricted medical license (Philippines or equivalent; eligibility for Indonesian work visa if required).
- Minimum 2+ years of clinical experience in a hospital, clinic, or healthcare setting.
- Experience in utilization review, case management, or medical auditing is a strong plus.
- Proficiency in medical terminology, coding (ICD-10, CPT), and healthcare compliance standards.
- Excellent analytical, communication, and documentation skills with attention to detail.
- Ability to work independently in a remote setting with reliable internet connectivity.
- Familiarity with EHR systems (e.g., Epic, Cerner) and Microsoft Office Suite.