job description
Are you a passionate Utilization Management Review Nurse looking to make a meaningful impact in the healthcare industry while enjoying the vibrant lifestyle of Bali? Med-Metrix International is seeking a detail-oriented and compassionate professional to join our dynamic team in a fully remote role based in Bali’s most sought-after locations, including Canggu, Ubud, and Denpasar.
In this role, you will play a critical part in ensuring that patients receive the appropriate level of care while optimizing healthcare resources. Your expertise will directly contribute to improving patient outcomes and streamlining healthcare processes. This is a unique opportunity to combine your clinical knowledge with administrative excellence in a supportive, international work environment.
At Med-Metrix International, we value innovation, integrity, and a patient-centered approach. If you are ready to take the next step in your nursing career with a globally recognized organization, we invite you to apply today!
Responsibility
- Conduct thorough utilization reviews to assess the medical necessity and appropriateness of patient care services.
- Collaborate with healthcare providers, insurers, and case managers to ensure compliance with clinical guidelines and policies.
- Analyze patient data and medical records to determine the most cost-effective and high-quality care plans.
- Provide clear and concise documentation of review findings, recommendations, and justifications for coverage decisions.
- Communicate effectively with patients, families, and healthcare teams to explain review outcomes and next steps.
- Identify opportunities for process improvements in utilization management to enhance efficiency and patient satisfaction.
- Stay updated on industry regulations, healthcare policies, and best practices in utilization review.
- Participate in interdisciplinary team meetings to discuss complex cases and develop patient-centered solutions.
Qualifications
- Active nursing license (RN) with a minimum of 2 years of clinical experience in a hospital, insurance, or managed care setting.
- Proven experience in utilization management, case management, or discharge planning is highly preferred.
- Strong knowledge of medical terminology, ICD-10 codes, and healthcare reimbursement models.
- Excellent analytical, critical thinking, and decision-making skills with attention to detail.
- Superb written and verbal communication skills in English to interact with diverse stakeholders.
- Proficiency in electronic health record (EHR) systems and Microsoft Office Suite.
- Ability to work independently in a remote setting while maintaining productivity and adherence to deadlines.
- Commitment to ethical standards, patient advocacy, and continuous professional development.