PH RN - Utilization Management - Pasay

We Search @ Searchers & Staffers Corp.; Pasay; Hybrid; PHP 334,800 - 446,400; Full time

Job summary

A leading healthcare placement firm is seeking a Philippine Registered Nurse (PHRN) for Utilization Management. This role involves applying clinical knowledge to support patient care coordination and reviewing medical necessity of healthcare services. Ideal candidates should have a Bachelor's degree in Nursing and at least one year of relevant experience. A hybrid work setup and night shift can be expected.

Qualifications

• BSN graduate required.
• 1+ years clinical or medical experience preferred.
• Experience in Utilization Management needed.

Responsibilities

• Perform utilization review and assess medical records.
• Review documentation for compliance with guidelines.
• Coordinate with healthcare providers and insurance companies.

Skills

Clinical assessment

Documentation skills

Communication skills

Analytical skills

Education

Bachelor of Science in Nursing (BSN)

Job description

Job Description

Insurance Health & Wellness

HMO

Job Title: Philippine Registered Nurse (PHRN) – Utilization Management

About the Role:

We are currently supporting a global healthcare and analytics organization in hiring Philippine Registered Nurses (PHRN) to join their Healthcare Operations team. This role is ideal for nurses who want to transition into a healthcare operations environment while still applying their clinical knowledge to support patient care coordination and utilization management.

Key Responsibilities:

• Perform utilization review and assess medical records to determine medical necessity of healthcare services
• Review clinical documentation and ensure compliance with healthcare guidelines and policies
• Coordinate with healthcare providers, insurance companies, and internal teams regarding patient care services
• Evaluate treatment plans and medical procedures based on established clinical criteria
• Document case findings, recommendations, and decisions accurately in the system
• Support quality assurance and compliance with healthcare standards
• Ensure timely processing of cases while maintaining accuracy and confidentiality

Qualifications:

• Bachelor of Science in Nursing (BSN) graduate
• At least one (1) year of clinical, hospital, or medical experience, or experience supporting US Healthcare accounts
• At least 1 year of Utilization Management experience
• Strong clinical assessment and documentation skills
• Good communication and analytical skills
• Willing to work on a night shift schedule
• Amenable to a hybrid work setup

Working Location

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