Coordinating Benefit Review Nurse

3 weeks ago

Trevose, United States International SOS Full time
Overall Purpose of the Role

The Philadelphia based Coordinating Benefit Review Nurse (CBRN) is responsible for facilitating and reviewing health care services requested under the health insurance policies of participating Japan-based US Federal Employee Health Benefit (FEHB) Program Carriers providing health insurance to US Government Civilians (Civs), working on behalf of the US Department of Defence.

Key Responsibilities

Core Responsibilities:
  • Conduct medical benefit reviews for inpatient and outpatient care, ensuring alignment with insurance policies.
  • Facilitate medical referrals and assessments for appropriate care, including collaboration with international centers in Tokyo and Manila.
  • Provide telephonic medical assessments, review treatment plans, and ensure adherence to carrier policies.
  • Maintain high standards of case management, detailed documentation, and patient confidentiality.

Case Escalation:
  • Follow escalation procedures for urgent medical cases, complex situations, or potential complaints.
  • Work closely with Medical Case Leads and escalate cases to the DoD Medical Director as needed.

Network Services:
  • Collaborate with medical providers and facilities to ensure high-quality care.
  • Participate in medical facility site surveys, audits, and provider evaluations as needed.

Medical Liaison and Reporting:
  • Produce medical reports to communicate patient progress and treatment to insurers.
  • Liaise with claims departments to ensure all medical and logistical information is accurately communicated.

Additional Responsibilities:
  • Work within International SOS's policies and uphold the organization's core values.
  • Attend training, team meetings, and pursue Continuing Professional Education (CPE).
  • Provide leadership in case management and contribute to team development.

Required Qualifications

Required Work Experience
• Experience of working in the medical insurance sector. Specifically, experience in medical benefit reviews and determinations
• Prior medical assistance experience, desirable but not essential.
• Previous medical insurance roles in a medical capacity (Nurse)

Required Qualifications
• Must hold current and unencumbered Registered Nurse license from any US State or Territory

Required Languages
• Written and spoken English (Business Level)

Travel / Rotation Requirements (Brief description of any travel or rotation requirements)
• This position may require local travel
• This role is an office-based position This is a business hours role, Monday to Friday based on Eastern Standard Time of 08:00AM - 06:00PM

This job description outlines the types of responsibilities the incumbent is required to perform. The incumbent may be required to perform job related tasks other than those specifically presented in this job description. This job description is subject to regular review.

International SOS is an equal opportunity employer and does not discriminate against employees or job applicants on the basis of race, color, religion, gender, sexual orientation, gender identity, national origin, age, disability, genetic information, marital status, amnesty or status as a covered veteran in accordance with applicable federal, state and local laws.

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