PHRN Wanted! Utilization Management Nurse | Quezon City
Concentrix Philippines
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Benefits offered by this job
Job summary
Concentrix Philippines is seeking a Utilization Management (UM) PHRN to review, process, and resolve UM cases with timely, clinically sound decisions. You will support case documentation and contribute to quality and compliance targets of the payer program.
The role requires a BSN with an active nursing license and at least six months of clinical process outsourcing or utilization management experience, plus six months bedside experience, with onsite work at Bridgetowne, Quezon City.
Qualifications
- BSN degree with active nursing license.
- 6 months background in clinical process outsourcing and utilization management (BPO).
- At least 6 months bedside experience.
- Willing to work onsite at Bridgetowne, Quezon City.
Responsibilities
- Review, processing, and resolution of UM cases.
- Ensure timely and clinically sound UM review and decisions.
- Uphold member rights and health plan obligations under CMS and commercial regulations.
- Support case documentation for payer program quality and compliance.
Skills
Education
Job description
The Utilization Management (UM) PHRN is responsible for the review, processing, and resolution of UM cases. The role ensures timely and clinically sound UM review, upholding member rights and health plan obligations under commercial and CMS regulations. The UM PHRN also supports case documentation and contributes to the quality and compliance targets of the payer program.
- Review, processing, and resolution of UM cases
- Ensure timely and clinically sound UM review
- Uphold member rights and health plan obligations under commercial and CMS regulations
- Support case documentation
- Contribute to the quality and compliance targets of the payer program
- College Graduate (BSN)
- Active Nursing License
- At least six (6) months background in clinical process outsourcing and clinical role handling utilization management (BPO)
- At least 6 months bedside experience
- Willing to work onsite at Bridgetowne, Quezon City
- HMO coverage, life insurance, leave conversion
- Fully Paid Training in communication, culture, and product expertise
- Education/Licensure Assistance Program with financial support for further studies and certifications
- Exclusive Partner Discounts
- High-Value Referral Bonuses
- Performance Incentives
- Night Shift Differential
- Mental Wellness Programs with professional support and wellness initiatives
- Clear, Accelerated Career Pathways with specialized courses, certifications, and language training
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