job description
Join Sales Rain BPO Inc. as a Utilization Review Nurse in beautiful Bali! In this pivotal role, you will collaborate with our Utilization Review Coordinator team to ensure optimal patient care through meticulous case evaluations and level-of-care determinations. Your expertise will directly impact healthcare delivery, ensuring patients receive the right care at the right time while maintaining compliance with regulatory standards.
This is a fantastic opportunity for a detail-oriented nurse who thrives in a dynamic, team-driven environment. Enjoy the vibrant culture of Bali while advancing your career in healthcare management. Apply today and become part of a company that values professional growth and work-life balance!
Responsibility
- Conduct thorough reviews of patient cases to determine appropriate levels of care.
- Collaborate with healthcare providers to gather necessary clinical information for case evaluations.
- Escalate complex cases to the Utilization Review Coordinator team for further assessment.
- Ensure compliance with healthcare regulations and company policies in all reviews.
- Document all case findings accurately and maintain detailed records.
- Provide recommendations for alternative care settings when appropriate.
- Participate in team meetings and training sessions to stay updated on best practices.
- Communicate effectively with patients, families, and healthcare teams regarding care decisions.
Qualifications
- Active nursing license (RN) in Indonesia or equivalent.
- Minimum of 2 years of clinical nursing experience, preferably in case management or utilization review.
- Strong knowledge of medical terminology, healthcare regulations, and insurance protocols.
- Excellent analytical and decision-making skills.
- Proficient in using healthcare management software and Microsoft Office Suite.
- Outstanding communication and interpersonal abilities.
- Ability to work independently and as part of a multidisciplinary team.
- Fluency in English; additional languages are a plus.