GET PHP75K SIGN ON BONUS! Utilization Management Nurse | Quezon City

Concentrix; Quezon City; On-site; PHP 279,000 - 446,000; Full time

Benefits offered by this job

HMO coverage

Life insurance

Leave conversion

Fully paid training

Education/licensure assistance

Partner discounts

Performance incentives

Night shift differential

Mental wellness programs

Career pathways with courses and certs

Job summary

Concentrix is seeking an UM PHRN to review, process, and resolve utilization management cases in a fast-paced healthcare outsourcing environment. The role emphasizes timely, clinically sound UM decisions and adherence to commercial and CMS regulations.

Based in Bridgetowne, Quezon City, you will work onsite, apply your BSN and nursing license, and collaborate with cross-functional teams to support quality, compliance targets, and member rights.

Qualifications

• BSN degree and active nursing license.
• Minimum six months background in clinical process outsourcing and utilization management.
• At least 6 months bedside experience.
• Willing to work onsite at Bridgetowne, Quezon City.

Responsibilities

• Review, processing, and resolution of UM cases
• Ensure timely and clinically sound UM review
• Uphold member rights and health plan obligations under commercial and CMS regulations
• Contribute to the quality and compliance targets of the payer program

Skills

Nursing license

Clinical process outsourcing

Bedside experience

Team collaboration

Education

BSN

Job description

The Utilization Management (UM) PHRN is responsible for the review, processing, and resolution of UM cases. The role ensures timely and clinically sound UM review, upholding member rights and health plan obligations under commercial and CMS regulations. The UM PHRN also supports case documentation and contributes to the quality and compliance targets of the payer program.

Key responsibilities

• Review, processing, and resolution of UM cases
• Ensure timely and clinically sound UM review
• Uphold member rights and health plan obligations under commercial and CMS regulations
• Contribute to the quality and compliance targets of the payer program

About you

• College Graduate (BSN)
• Active Nursing License
• At least six (6) months background in clinical process outsourcing and clinical role handling utilization management (BPO)
• At least 6 months bedside experience
• Willing to work onsite at Bridgetowne, Quezon City
• HMO coverage, life insurance, leave conversion
• Fully Paid Training in communication, culture, and product expertise
• Education/Licensure Assistance Program with financial support for further studies and certifications
• Exclusive Partner Discounts
• Performance Incentives
• Night Shift Differential
• Mental Wellness Programs with professional support and wellness initiatives
• Clear, Accelerated Career Pathways with specialized courses, certifications, and language training