Clinical Review Nurse — Medical Necessity & Utilization Management

Global Recruitment and Consultancy OPC; Taguig; On-site; PHP 360,000 - 480,000; Full time

Job summary

Global Recruitment and Consultancy OPC in the Philippines is seeking an experienced USRN-licensed nurse to support utilization management, medical necessity reviews, and clinical documentation. The role emphasizes accurate record review, clear reporting, and collaboration with healthcare stakeholders.

You will contribute to utilization management processes while maintaining high standards of clinical documentation and communication.

Qualifications

• Current and unrestricted US Registered Nurse (USRN) license.
• At least 480 hours of direct patient-care RN experience.
• Minimum 6 months of Utilization Management or Utilization Review experience.
• Strong English communication and clinical documentation skills.
• Good analytical and computer skills.

Responsibilities

• Review medical records and clinical documentation.
• Evaluate cases based on medical necessity and established guidelines.
• Prepare clear and accurate clinical summaries.
• Identify documentation gaps and follow up on required information.
• Communicate clinical findings with healthcare and clinical stakeholders.
• Support Utilization Management processes and healthcare operations.

Skills

USRN license

RN experience

Utilization Management

English skills

Analytical skills

Computer skills

Job description

Global Recruitment and Consultancy OPC in the Philippines is seeking an experienced USRN-licensed nurse to support utilization management, medical necessity reviews, and clinical documentation. The role emphasizes accurate record review, clear reporting, and collaboration with healthcare stakeholders.

You will contribute to utilization management processes while maintaining high standards of clinical documentation and communication.