Position Responsibilities:
Assess clinical needs and determine initial eligibility for long-term care benefits using clinical evidence and established guidelines.Review onsite/virtual assessments, functional and cognitive screening results, and supporting documentation to make benefit eligibility decisions.Monitor ongoing claims, particularly those with high-risk activity, and conduct clinical follow-ups in accordance with current protocols.Collaborate with senior care management and cross-functional teams to ensure accurate claim decisions and provide excellent customer service.Maintain up-to-date knowledge of clinical protocols and guidelines by completing required training programs.Participate in regular meetings, one-on-ones, and other team activities to support operational goals and continuous improvement.Required Qualifications:
Active Philippine Registered Nurse (PHRN) and US Registered Nurse (...