job description
Are you a highly skilled US Registered Nurse looking to leverage your clinical expertise in a modern, remote-first environment? Shearwater Health is expanding our clinical operations team and seeking dedicated professionals to join our remote workforce in Metro Manila.
In this critical role, you will bridge the gap between clinical practice and administrative excellence. You will be responsible for meticulously summarizing complex clinical documentation, providing evidence-based clinical guidelines, and drafting medical necessity determinations to ensure high-quality patient care and operational efficiency. This is an excellent opportunity for nurses who are detail-oriented, analytical, and eager to transition into a corporate healthcare role without stepping away from their clinical roots.
By joining Shearwater Health, you become part of a global community dedicated to improving healthcare outcomes. We offer a supportive work environment, professional growth opportunities, and the flexibility of remote work, allowing you to advance your career from the comfort of your home.
Responsibility
- Analyze and summarize complex medical records, clinical notes, and diagnostic reports accurately.
- Draft medical necessity determinations based on established clinical policies and insurance guidelines.
- Provide clinical consultation and evidence-based guidelines to support administrative decision-making processes.
- Maintain compliance with HIPAA regulations and company data privacy standards during all documentation reviews.
- Collaborate with cross-functional teams to ensure high standards of clinical documentation and review turnaround times.
- Identify inconsistencies or gaps in clinical documentation and recommend necessary follow-up actions.
- Participate in ongoing training sessions to stay updated on current US healthcare regulations and clinical coding standards.
Qualifications
- Active and unrestricted US Registered Nurse (RN) license.
- Minimum of 2-3 years of clinical bedside or acute care experience in a US healthcare setting.
- Strong proficiency in reviewing and interpreting clinical documentation, medical charts, and EMR systems.
- Excellent written and verbal communication skills in English, specifically regarding medical terminology.
- High level of analytical and critical thinking skills with a focus on medical necessity and utilization review.
- Reliable home office setup with high-speed internet connectivity for remote work requirements.
- Ability to work independently with minimal supervision while meeting strict production and quality deadlines.