Medical Review Nurse

Description

About the Role

The Medical Review Nurse is responsible for reviewing medical reports for TRICARE beneficiaries, determining case closure or need for follow-up care, and issuing authorizations when required. The role involves coordinating with beneficiaries, healthcare providers, and internal teams to ensure accurate, timely, and high‑quality case processing.

Key Responsibilities

• Review and validate incoming medical reports for accuracy and completeness.
• Close cases or perform benefit reviews as needed; issue authorizations or denials.
• Coordinate with network providers for required follow-up care.
• Communicate updates to beneficiaries and clients via email.
• Escalate complex cases or complaints to the Team Leader.
• Maintain confidentiality and accurate case documentation.
• Collaborate with cross-functional teams to support beneficiary care.
  
  

• Active Philippines Registered Nurse license (valid for at least 12 months).
• Bachelor of Science in Nursing.
• At least 2 years clinical experience; broad nursing background preferred.
• Experience in utilization management, case management, or medical report review is a plus.
• Excellent written and spoken English; computer literacy required.
• US RN license desirable but not required.
  
  

• Strong attention to detail and adherence to procedures.
• Effective communication and teamwork.
• Ability to manage time and organize tasks efficiently.
• High standards for quality and customer service.
  
  

• Be part of a global organization dedicated to providing exceptional medical and travel security services.
• Work in a dynamic and supportive environment.
• Opportunity to make a meaningful impact on the health and well-being of our clients.