Clinical Review Specialist | USRN

Sutherland; Taguig; On-site; PHP 420,000 - 540,000; Full time

Job summary

Sutherland in Taguig is seeking a Clinical Review Specialist with a USRN and strong clinical judgment to review medical records, assess complex cases, and provide evidence-based recommendations.

This full-time onsite role in BGC requires at least 1 year of nursing experience, sharp analytical skills, and the ability to collaborate with physicians and other healthcare professionals.

Qualifications

• Active and unrestricted USRN license.
• Minimum 1 year of clinical nursing experience.
• Strong medical record review and clinical assessment skills.
• Excellent written and verbal English communication.
• Strong stakeholder management and interpersonal skills.

Responsibilities

• Review medical records, claims, and supporting documentation.
• Analyze complex cases and provide clinically sound recommendations.
• Apply critical thinking, clinical reasoning, and professional nursing judgment.
• Collaborate with physicians, healthcare professionals, employees, insured members, and internal stakeholders.
• Participate in discussions involving sensitive and complex medical concerns.
• Provide clinical guidance and education to non-medical colleagues.
• Maintain high standards of quality, accuracy, productivity, and service.

Skills

USRN license

Clinical nursing experience

Analytical skills

English communication

Stakeholder management

On-site collaboration

Job description

Are you a USRN with strong clinical judgment, analytical skills, and a passion for making meaningful healthcare decisions?

We’re looking for a Clinical Review Specialist who can use their nursing expertise to review complex medical cases, evaluate clinical documentation, and provide objective, evidence-based recommendations.

Work Setup:100% Onsite — BGC, Taguig

Experience: At least 1 year of clinical nursing experience

What You’ll Do

• Review medical records, claims, and supporting documentation
• Analyze complex cases and provide clinically sound recommendations
• Apply critical thinking, clinical reasoning, and professional nursing judgment
• Collaborate with physicians, healthcare professionals, employees, insured members, and internal stakeholders
• Participate in discussions involving sensitive and complex medical concerns
• Provide clinical guidance and education to non-medical colleagues
• Maintain high standards of quality, accuracy, productivity, and service

What We’re Looking For

• Active and unrestricted USRN license
• Minimum 1 year clinical nursing experience
• Strong medical record review and clinical assessment skills
• Excellent analytical, critical-thinking, and decision-making abilities
• Strong written and verbal English communication skills
• Excellent stakeholder management and interpersonal skills
• Willingness to work onsite full-time in BGC, Taguig
• Candidates outside Metro Manila must be willing to relocate

Preferred: Experience in Behavioral Health, Mental Health, Psychiatric Nursing, Utilization Management, Case Management, Disability Management, Clinical Review, or Insurance Healthcare