job description
Join Sales Rain BPO Inc. as a Utilization Review Nurse and play a pivotal role in ensuring optimal patient care while managing healthcare resources efficiently. Based in the vibrant and serene environment of Bali, Indonesia, this remote position offers you the unique opportunity to balance professional excellence with an unparalleled work-life experience.
As a Utilization Review Nurse, you will collaborate closely with our Utilization Review Coordinator team to assess and determine the appropriate level of care for patients. Your clinical expertise will be instrumental in reviewing medical cases, ensuring compliance with healthcare standards, and facilitating cost-effective, high-quality care solutions. This role is ideal for licensed nurses who are detail-oriented, analytical, and passionate about improving healthcare outcomes.
At Sales Rain BPO Inc., we value your skills and offer a competitive compensation package, flexible remote work options, and the chance to be part of a dynamic, international team. Embrace the opportunity to make a meaningful impact in healthcare while enjoying the tropical paradise of Bali.
Responsibility
- Conduct thorough reviews of patient medical records to determine the appropriateness of care levels and treatment plans.
- Collaborate with healthcare providers, case managers, and insurance teams to ensure alignment on patient care decisions.
- Assess and escalate complex cases to the Utilization Review Coordinator for further evaluation and resolution.
- Document and maintain accurate records of all utilization review activities, ensuring compliance with regulatory and company policies.
- Provide clinical expertise and recommendations to optimize patient outcomes while managing healthcare costs.
- Communicate effectively with patients, families, and healthcare teams to explain care determinations and next steps.
- Stay updated on industry best practices, healthcare regulations, and utilization review guidelines.
- Participate in team meetings and training sessions to enhance skills and share knowledge with colleagues.
Qualifications
- Active and unrestricted Nursing License (RN) in Indonesia or equivalent international certification.
- Minimum of 2 years of clinical nursing experience, preferably in utilization review, case management, or a related field.
- Strong understanding of medical terminology, healthcare policies, and utilization review processes.
- Excellent analytical, communication, and interpersonal skills to interact with diverse stakeholders.
- Proficiency in using electronic health records (EHR) and healthcare management software.
- Ability to work independently in a remote setting while maintaining high productivity and attention to detail.
- Familiarity with healthcare compliance standards (e.g., HIPAA, local regulations) is a plus.
- Fluency in English (written and verbal) is required; additional languages are a benefit.