Nurse Utilization Review Manager — Lead Care Coordination

Health Business Solutions LLC; Cebu City; On-site; PHP 900,000 - 1,300,000; Full time

Job summary

Health Business Solutions LLC in Cebu City is seeking a Manager, Utilization Review to lead a team of Utilization Review Nurses and oversee daily UR operations. The role focuses on care coordination, cost management, and maintaining high-quality patient care standards.

You will drive performance through staff development, quality improvement initiatives, and collaboration with the healthcare team to optimize outcomes. Strong leadership and regulatory knowledge are essential.

Qualifications

• Current RN license with valid registration.
• BSN required; MSN preferred for leadership in Utilization Review.
• Experience in case management or care coordination with at least 2 years in a leadership role.
• Strong clinical assessment and critical thinking skills.
• Excellent communication and interpersonal skills.
• Knowledge of healthcare regulations and quality improvement methodologies.

Responsibilities

• Lead and mentor a team of Utilization Review Nurses.
• Oversee development and implementation of individualized care plans.
• Collaborate with healthcare professionals to ensure coordinated patient care.
• Monitor care plan effectiveness and resource utilization.
• Drive quality improvement initiatives and regulatory compliance.
• Manage department budget and optimize resource allocation.
• Provide ongoing staff education on best practices and regulations.
• Serve as patient advocate and participate in complex case reviews.
• Ensure accurate documentation in patient records per regulatory standards.

Skills

Leadership

Team Management

Care Coordination

Budget Management

Staff Development

Patient Advocacy

Regulatory Knowledge

Communication

EHR Proficiency

Data Analysis

Education

BSN

RN license

MSN (preferred)

Tools

EHR software

Healthcare software

Job description

Health Business Solutions LLC in Cebu City is seeking a Manager, Utilization Review to lead a team of Utilization Review Nurses and oversee daily UR operations. The role focuses on care coordination, cost management, and maintaining high-quality patient care standards.

You will drive performance through staff development, quality improvement initiatives, and collaboration with the healthcare team to optimize outcomes. Strong leadership and regulatory knowledge are essential.