Clinical Review Nurse: Evidence-Based Case Evaluator

Sutherland; Taguig; On-site; PHP 420,000 - 660,000; Full time

Job summary

Sutherland is seeking a Clinical Review Specialist on-site in BGC, Taguig, Philippines. This role focuses on assessing complex medical cases, providing evidence-based recommendations, and collaborating with healthcare professionals and business stakeholders.

A USRN license and at least 1 year of clinical nursing experience are required. You will review medical information, lead high-impact discussions, and coach colleagues on clinical concepts while ensuring accuracy and timely deliverables in a

Qualifications

• Active and unrestricted US Registered Nurse (USRN) license.
• Minimum of 1 year of clinical nursing experience.
• Strong clinical assessment and medical record review skills.
• Excellent written and verbal English communication skills.

Responsibilities

• Review and evaluate medical records, claim files, and documentation using evidence-based clinical standards.
• Analyze complex medical information and provide objective, clinically supported assessments and recommendations.
• Apply advanced critical thinking and clinical reasoning in case reviews with varying complexity.
• Lead discussions with internal and external stakeholders on sensitive medical issues.
• Challenge information or recommendations when clinical evidence indicates a different course of action.
• Collaborate with Business/Leave Services teams, employees, insured members, physicians, and other professionals to gather medical information.
• Coach and educate non-medical colleagues on relevant medical concepts and case considerations.
• Maintain productivity and consistently meet quality, accuracy, and service-level expectations.
• Demonstrate adaptability, urgency, and sound judgment in a fast-paced environment.
• Stay current with industry trends, clinical best practices, and licensing requirements.

Skills

USRN license

Clinical assessment

Stakeholder management

English communication

Analytical reasoning

Job description

Sutherland is seeking a Clinical Review Specialist on-site in BGC, Taguig, Philippines. This role focuses on assessing complex medical cases, providing evidence-based recommendations, and collaborating with healthcare professionals and business stakeholders.

A USRN license and at least 1 year of clinical nursing experience are required. You will review medical information, lead high-impact discussions, and coach colleagues on clinical concepts while ensuring accuracy and timely deliverables in a