Manager, Utilization Review Nurse
5 days ago
Prudential's purpose is to help people get the most out of life. We will deliver our purpose by creating a culture in which diversity is celebrated and inclusion assured, for our colleagues, customers, and partners. We provide a platform for our people to do their best work and make an impact to the business, and in exchange, we support our people's career ambitions. We pledge to make Prudential a place where you can Connect, Grow and Succeed.
**Job Description**:
Medical Management & Utilization Review:
- Perform concurrent reviews and on-site for patients using Health Integrated behavioral health criteria
(Indication of admission and Length of Stay as a guideline, calculates the lengths of stay and continued-stay days for patients)
to ensure that the indication of admission and extended stays are medically justified, appropriateness, and documented in patient's medical records.
- Refer to the Utilization Review Physician for all cases that do not meet established guidelines for admission or continued stay.
- Identify problems related to the quality of patient care and refer such problems to Head of medical underwriting and claim COE
- Management of medical costs through timely concurrent review and retrospective review.
- Collect and summarize concurrent review report as assigned area every month and send all data to analyze by Medical analysis to be sent to the hospital network.
- Communicate with hospital networks to resolve instances of inappropriate utilization.
Qualifications:
- Bachelor’s degree, a specialization in nursing being a strong plus
- 3+ previous experience in UR nurse or claim administration
- Fluent in both written and spoken English
- Flexibility on the working hours will be expected
- Flexibility, adaptation, and a good mindset are key values for this role
Have excellence communication, interpersonal and analytical skills
-
Supervisor, Utilities
1 week ago
ประเวศ, กรุงเทพมหานคร, Thailand Pandora Jewelry Full timeReq. 13948 **[Key objectives]** - Implementation plants with sufficient HVAC, and utility engineering capabilities to ensure uninterrupted business operations - Implementation effective and optimal operations of utilities, and other general facilities within production plants **[Key duties]** - Plan and summarize the maintenance of Utility. That affects...
-
Nurse Assessor
1 week ago
กรุงเทพมหานคร, Thailand Sunday Insurance Full time**Everyday you will...** - Daily monitoring of all medical claims. - Manage the expectation of customers in line with Company’s direction - Verifying claims documents vs policy terms & conditions to ensure genuineness of claim within policy coverage - Coordinate between customers, broker, service providers to ensure excellent service - Coordinating with...
-
Nurse Assessor
1 week ago
กรุงเทพมหานคร, Thailand Sunday Insurance Full time**Everyday you will...** - Daily monitoring of all medical claims. - Manage the expectation of customers in line with Company’s direction - Verifying claims documents vs policy terms & conditions to ensure genuineness of claim within policy coverage - Coordinate between customers, service providers to ensure excellent service - Coordinating with Accident &...
-
Nurse Coordinator
3 weeks ago
กรุงเทพมหานคร, Thailand April Asia Pacific Full timeFor over 30 years, APRIL International Care has been specialising in international health insurance solutions. We design, distribute, and manage insurance plans and assistance services for individuals and businesses. With teams across Asia, Europe, and America, we look after our members wherever they are to make sure they access proper care. We are part of...
-
พยาบาลวิชาชีพ (Ur Nurse)
2 weeks ago
บึงกุ่ม, กรุงเทพมหานคร, Thailand Phyathai Hospital Full time**ลักษณะงาน** - เป็นผู้ชำนาญการด้านคลินิคและบริการ ประสานงาน และที่ปรึกษาให้ฝ่ายแพทย์, พยาบาล และบริษัทประกัน...
-
Nurse / Personal Assistant
2 weeks ago
กรุงเทพมหานคร, Thailand บริษัท อมตะ คอร์ปอเรชัน จำกัด (มหาชน) Full time**Nurse / Personal Assistant**: - Company: - AMATA Corporation PCL- Location: - AMATA Bangkok Office**Key Responsibilities**: - Provides some basic professional medical care and advise, perform nursing assistant to the executive if necessary. - Work closely with the executive and take care of medical care. - Manage personal executive's appointments and...
-
Nurse Manager
1 week ago
จตุจักร, กรุงเทพมหานคร, Thailand เมโกะ คลินิกแพทย์บริษัท บิวติเพล็กซ์ จำกัด Full timeสุขภาพ/โรงพยาบาล, ความงาม/เครื่องสำอางค์ วันนี้ คุณสมบัติพื้นฐาน งานประจำ 2 - 4 ปี กทม. (จตุจักร) ปริญญาตรี 40,000 - 80,000...
-
Nurse Coordinator
4 weeks ago
กรุงเทพมหานคร, Thailand April Asia Pacific Full timeFor over 30 years, APRIL International Care has been specializing in international health insurance solutions. We design, distribute, and manage insurance plans and assistance services for individuals and businesses. With teams across Asia, Europe, and the Americas, we look after our members wherever they are to make sure they have access to the best...
-
Registered Nurse
3 weeks ago
กรุงเทพมหานคร, Thailand MSpa Full timeCompany Description Operating over 70 spas worldwide, MSpa is an international driving force in Spa & Wellness. MSpa’s journey began in Thailand in 1999 with Mandara Spa, and has since evolved and expanded to include the renowned Anantara Spa and AvaniSpa brand, as well as bespoke concepts. Our award winning spas continue to grow and adapt to suit the Spa...
-
Journalist
7 days ago
กรุงเทพมหานคร, Thailand Telecom Review Full timeHave a minimum of 1 year experience in the field - Fluent in English and have exceptional grammar and writing skills - Editorial background in business or technology reporting is a plus, but not required - Having an experience in conducting interviews, and covering events is an advantage - Have excellent time management and organizational skills **Job...
-
Medical Content Reviewer
2 weeks ago
กรุงเทพมหานคร, Thailand Pfizer (Thailand) Limited Full timeWork collaboratively with Medical and Commercial teams to review promotional, Medical-to-Medical (M2M), regulatory, training, and continuing medical education materials in compliance with relevant SOPs, regulations, industry codes, and best practices. Ensure scientific and medical accuracy of materials throughout MLR review process. Provide critical review...
-
Clinical Implementation Manager
2 weeks ago
กรุงเทพมหานคร, Thailand Smart Search Recruitment Full timeOur client is a well-known European Pharmaceutical company that specializes in diagnostic solutions and has been established for over 50 years with operations spanned across 5 continents and a reputation for being at the forefront innovative healthcare solutions. In Thailand, they operate an office, serving as a regional hub of operations for Indochina. Due...
-
Credit Review
2 weeks ago
วัฒนา, กรุงเทพมหานคร, Thailand United Overseas Bank (Thai) PCL - UOB Full timeCredit analysis for customer whose credit. Credit Review. Wholesale Credit Review. Job Responsibilities. Perform credit review following the plan, procedure and guideline that set forth in compliance with regulation and policy of Bank and BOT. Identify the negative issues that considered as an impairment to the loan quality in order to early notify the...
-
Nurse and Technician
1 week ago
กรุงเทพมหานคร, Thailand OOCA Full timePerform comprehensive assessments of patients' mental health conditions and create individualized care plans. **1. Patient Care** - Administer medications and treatments according to physicians' orders and established protocols. - Monitor patients' vital signs, reactions to medications, and overall mental health status. - Collaborate with interdisciplinary...
-
Medical Affairs Manager
1 week ago
บางรัก, กรุงเทพมหานคร, Thailand PRTR Full timeOur client is a leading global provider of Nutrition. The company comprises professionals passionate about their role in bringing their Nutrition to their customers worldwide. This position is responsible for developing scientific information to support marketing materials. **Responsibilities** - Liaising with the global team on marketing concepts,...
-
Logistic Manager
1 week ago
กรุงเทพมหานคร, Thailand Ancor Full timeWe are working with a leading Insurance Technology company for a **Logistic Manager **position In this position you will be involved in the day-to-day operation in providing the best customer experience through adequate supply and availability of logistics vendors which includes third logistics and on-demand courier strategically positioned to respond to...
-
Senior Sales Manager
6 days ago
กรุงเทพมหานคร, Thailand SAP Full time**What we offer** **Senior Sales Manager**'s primary responsibilities include prospecting, qualifying, selling and closing new business to existing and net new customers. The Account Executive brings a Point of View to the Customer engagement; uses all resources to solve customer problems with appropriate SAP products. **1. Account and Customer...
-
Senior Sales Manager
5 days ago
กรุงเทพมหานคร, Thailand SAP Full time**What we offer** **Senior Sales Manager**'s primary responsibilities include prospecting, qualifying, selling and closing new business to existing and net new customers. The Account Executive brings a Point of View to the Customer engagement; uses all resources to solve customer problems with appropriate SAP products. **1. Account and Customer...
-
กรุงเทพมหานคร, Thailand Labcorp Full time**Essential Job Duties**: - Responsible for all aspects of study site monitoring including routine monitoring and close-out of clinical sites, maintenance of study files, conduct of pre-study and initiation visits, with or without guidance (as per the training status of the CRAI-MEA); liaise with vendors; and other duties, as assigned - Responsible for...
-
Clinical Data Associate
2 weeks ago
ปทุมวัน, กรุงเทพมหานคร, Thailand ศูนย์ประสานความร่วมมือระหว่างไทย-ออสเตรเลีย-เนเธอร์แลนด์ เพื่อการศึกษาวิจัยทางคลินิกด้านโรคเอดส์ Full timeบริษัท: - ศูนย์ประสานความร่วมมือระหว่างไทย-ออสเตรเลีย-เนเธอร์แลนด์ เพื่อการศึกษาวิจัยทางคลินิกด้านโรคเอดส์ - รายละเอียดงาน: - Reviews...