On-Site USRN Utilization Management Nurse Specialist

Gratitude Philippines

Manila

On-site

PHP 600,000 - 900,000

Full time

3 days ago

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Job summary

Gratitude Philippines is seeking qualified US Registered Nurses to join our Healthcare program as Clinical Utilization Management Nurse Specialists. The role focuses on reviewing prior authorizations and concurrent reviews to ensure medical necessity within a US managed care environment.

Work is on-site in Quezon City with a US Day Shift schedule. Start date is on or before December 15, with compensation aligned to the client budget.

Qualifications

BSN degree from an accredited nursing school.
Active US RN license (USRN).
NCLEX examination passed.

Responsibilities

Review prior authorization and/or concurrent review requests to determine medical necessity and level of care.
Coordinate with healthcare providers and internal teams to facilitate timely case reviews and resolutions.
Escalate cases needing higher-level clinical assessment to Medical Directors.
Support discharge planning and transfer authorization workflows for concurrent review cases.
Document clinical findings, review outcomes, and decisions clearly in records.
Provide guidance to providers and internal teams on utilization management processes.
Ensure timely handling of clinical review requests while maintaining quality and standards.