RN - International SOS : Job Details

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.

This is a business hours role, Monday to Friday based on Eastern Standard Time between hours 8A-6P with hybrid possibility available post-training

CORE CBRN ACTIVITIES

• Understand the importance and conduct high standards of follow the sun support to TYO and MNL.
• Participate and validate in a manner that focuses on facilitating appropriate care (inpatient and outpatient) through the provision of medical referral and medical information, that is provided to the insurer in support of a medical benefit claim.
• Compliant with International SOS First call and code blue procedure, where applicable..
• Review appropriateness of health care services that are being requested by the member ensuring these reviews are consistent with the client's carrier policies and industry standards.
• CBRN's will collect logistical, medical, and collateral case histories pertaining to the medical event / incident to enable the patient's referral to the most appropriate medical facility and with the appropriate specialist.
• CBRN's are responsible for medical due diligence and direction information and service delivery with respect to requests for insurance coverage for medical treatment required.
• Responsible for the medical referral for patients to an appropriate level of care, clinical specialty, and provider ensuring that decisions are documented clearly in the patient management system.
• Provision of assistance with referrals and retrospective claims assessments as required..
• CBRN's will share information with relevant centres (TYO and MNL) that is succinct, timely and documented accurately.
• Provide telephone medical assessment for patients and monitor the appropriateness of the treatment being administered by the treating medical facility, in line with the carrier (insurers) policy terms and conditions.
• CBRN's will produce medical reports that effectively communicate medical progress and information to the insurer, which can be utilised in determining whether treatment being administered, or that may be required, is provided under the patient's health insurance coverage.
• When there is a language barrier (i.e., provider is Japanese), initiate contact with Japanese medical personnel based in the Tokyo Assistance Centre.
• Where assistance / support is required by Japanese medical / operations team members (referral support, translation, appointment booking, obtaining information from treating physician) initiate contact with the TYO centre for support

CASE ESCALATION

• As per DoD Civilian Program escalation process to Medical Case Lead (physician)
• The follow the sun team (PHL) will also escalate to the DoD Medical Director for awareness.
• Escalation as per International SOS protocol to the Medical Case Lead of individual Assistance Centres for medical urgent and emergent situations, possible complaint cases, unusual scenarios, and potential transport cases.

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 registration to practice in country of services being provided.

• Registered Nurse

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 with the ability for some remote work based on performance.