Onsite Utilization Management Nurse Specialist – Day Shift

ROUXEL TP; Philippines; On-site; PHP 480,000 - 720,000; Full time

Job summary

ROUXEL TP is seeking a Clinical Utilization Management Nurse Specialist (USRN) to review prior authorization and concurrent requests against clinical guidelines within a US managed care setting. The role is onsite at TP Vertis North with US daytime hours.

Responsibilities include coordinating with providers, escalating cases to Medical Directors, supporting discharge planning, and ensuring accurate documentation.

Qualifications

• Graduate of an accredited School of Nursing; BSN
• Active USRN license (NCLEX-passed), non-restricted
• 1-year clinical experience (hospital, clinic, or academe) plus 1 year in UM (Prior Authorization, or Concurrent Review - preferred) or 2 years in UM, Prior Authorization, or Concurrent Review - preferred
• Knowledge of Medicare/Medicaid and managed care fundamentals
• Strong analytical, documentation, and communication skills
• Amenable to US shift and onsite/hybrid setup

Responsibilities

• Review prior authorization and/or concurrent requests for medical necessity and level of care
• Coordinate with providers and internal teams for timely case resolution
• Escalate cases requiring higher-level review to Medical Directors
• Support discharge planning and transfer authorization workflows (for concurrent)
• Document clinical information accurately and in compliance with standards
• Provide utilization process guidance to providers and internal teams

Skills

Analytical skills

Documentation skills

Communication skills

USRN license

Education

BSN

Tools

InterQual

MCG

Job description

ROUXEL TP is seeking a Clinical Utilization Management Nurse Specialist (USRN) to review prior authorization and concurrent requests against clinical guidelines within a US managed care setting. The role is onsite at TP Vertis North with US daytime hours.

Responsibilities include coordinating with providers, escalating cases to Medical Directors, supporting discharge planning, and ensuring accurate documentation.