All jobs
Position Title: USRN Hiring Manila Shift: Job Description: Responsible for collaborating with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources. Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and clinical guidelines, accurately interpreting benefits, and managed care products, and steering members to appropriate providers, programs or community resources. Works with medical directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied. Primary duties may include, but are not limited to: Conducts pre-certification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts. Ensures member access to medically necessary, quality healthcare in a cost effective setting according to contract. Consults with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process. Collaborates with providers to assess member’s needs for early identification of and proactive planning for discharge planning. Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications. Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards. Requires a BSN, current active unrestricted RN license to practice as a health professional in applicable state(s) of the United States, and 1 year of acute care clinical experience or case management, utilization management or managed care experience, which would provide an equivalent background. Healthcare related certification and/or Master’s degree a plus. Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. Care meets innovation Our name translates to “providing full and complete care” and reinforces our commitment to putting people first in all that we do. We specialize in contact center operations (call and chat) and clinical nurse operations for Elevance Health. With four offices in prime locations across the Philippines—two in Manila and two in Iloilo—we boast a talent pool of more than 9,000 associates all working together to improve healthcare operations. We use the right balance of care, technology, data, and expertise to streamline experiences and create value for our clients, people, and community. We also recognize the value that our associates bring, and that is why we are committed to providing the same through competitive compensation and comprehensive benefits such as rewards and recognition programs, health and medical insurance, and best-in-class amenities to keep associates and their families healthy and secure. At Carelon Global Solutions Philippines, we care for those who provide care. Join us today. We celebrate and leverage our associates' limitless skills, talents, unique perspectives, and experiences. By respecting our people's culture and background, we foster a collaborative and purpose-driven workplace where everyone can grow and thrive in their careers. If you are a recent senior high school or college graduate looking to get a head start in your career, we are the right team for you. Our people-first approach supports professional development by providing associates with the right tools and training that align with their aspirations. Details Details Details 
DetailsDetails 
Details
DetailsDetails
elevancehealth
PHL-Taguig City-Alliance Global Tower
USRN Hiring Manila.
more at elevancehealth.
6 Oct, 2026
elevancehealth
Databricks - Tech Lead II - GR - 40516-75564 - JR206256
- Full time
- Senior level
- Engineering
IND-KA-Bengaluru +2
Full time
6 Oct, 2026
elevancehealth
Databricks - Associate Architect II - GR - 40516-75570 -JR206254
- Full time
- Senior level
- Engineering
IND-KA-Bengaluru +2
Full time
6 Oct, 2026
elevancehealth
Sr Software Engineer III - AI (IND)
- Full time
- Senior level
- Data & ML
IND-KA-Bengaluru +2
Full time
similar roles.
22 Oct, 2026
prudentialplc.com
Competence Development Specialist (1 Year Contract)
- Contract
PACS +3
Contract
22 Oct, 2026
prudentialplc.com
銀行業務發展_保險顧問襄理(南一區IC)
PCALT +1
Salary not listed
21 Oct, 2026
adobe.com
2027 MBA Intern - Digital Strategy Associate, Strategic Advisory
- Internship
- Intern
New York, United States of America
Internship
22 Oct, 2026
NETZSCH Group
Schnupperpraktikant (m/w/d)
- Internship
Tirschenreuth, de
Internship
22 Oct, 2026
NETZSCH Group
Werkstudent / Praktikant (m/w/d)
- Internship
- Intern
Selb, de
Internship