PHRN – Utilization Review Nurse | Night Shift | Onsite (QC C-5)

Concentrix Philippines; Quezon City; On-site; PHP 279,000 - 502,000; Full time

Job summary

Concentrix Philippines seeks dedicated Philippine Registered Nurses (PHRN) to join our healthcare operations as PHRN Frontline representatives. You will apply your clinical expertise and healthcare BPO experience to manage medical reviews and utilization management tasks, supporting patient care processes.

Based in Bridgetowne, Quezon City, the role emphasizes medical documentation review, compliance with client protocols, and collaboration with providers, payers, and patient support teams.

Qualifications

• Must be an active Philippine Registered Nurse (PHRN) with a valid PRC license.
• Minimum of 6 months of bedside/hospital clinical nursing experience.
• Minimum of 6 months of BPO healthcare experience focused on Utilization Management (UM) or Utilization Review (UR).
• Strong communication, analytical, and critical thinking skills.
• Proficient in medical terminology and clinical documentation review.

Responsibilities

• Perform medical necessity reviews and utilization management/review tasks according to healthcare guidelines.
• Evaluate clinical documentation and medical records to determine coverage or care appropriateness.
• Handle frontline communication and coordination with healthcare providers, payers, and patient support teams.
• Ensure compliance with client protocols, healthcare regulations, and quality standard operating procedures.

Skills

Communication skills

Analytical thinking

Critical thinking

Medical terminology

Clinical documentation

Education

PHRN / PRC-licensed

Job description

We are seeking dedicated and detail-oriented Philippine Registered Nurses (PHRN) to join our healthcare operations team as PHRN Frontline representatives. In this role, you will leverage your clinical expertise and healthcare BPO experience to manage medical reviews, utilization management tasks, and support patient care processes.

Requirements:

• Education & License: Must be an active Philippine Registered Nurse (PHRN) with a valid PRC license.

• Clinical Experience: Minimum of 6 months of bedside/hospital clinical nursing experience.

• BPO Experience: Minimum of 6 months of BPO healthcare experience specifically focused on Utilization Management (UM) or Utilization Review (UR).

• Strong communication, analytical, and critical thinking skills.

• Proficient in medical terminology and clinical documentation review.

Key Responsibilities:

• Perform medical necessity reviews and utilization management/review tasks according to healthcare guidelines.

• Evaluate clinical documentation and medical records to determine coverage or care appropriateness.

• Handle frontline communication and coordination with healthcare providers, payers, and patient support teams.

• Ensure compliance with client protocols, healthcare regulations, and quality standard operating procedures.

Work Location:

Bridgetowne, Quezon City