PHRN Wanted! Utilization Management Nurse | Quezon City

Concentrix; Quezon City; On-site; PHP 360,000 - 540,000; Full time

Benefits offered by this job

HMO coverage

Life insurance

Leave conversion

Fully paid training

Education/licensure assistance

Partner discounts

Performance incentives

Night shift differential

Mental wellness programs

Career pathways

Job summary

Concentrix in Quezon City, Philippines, is seeking an UM PHRN to review, process, and resolve utilization management cases ensuring timely, clinically sound decisions. The role supports member rights and health plan obligations under CMS and commercial regulations and contributes to payer program quality and compliance.

The candidate should hold a BSN with an active nursing license and have at least 6 months of clinical outsourcing and utilization management experience, plus bedside exposure.

Qualifications

• BSN degree required.
• Current active nursing license.
• 6+ months experience in clinical outsourcing and utilization management.
• 6+ months bedside nursing experience.
• Willing to work onsite in Bridgetowne, Quezon City.

Responsibilities

• Review, processing, and resolution of UM cases.
• Ensure timely and clinically sound UM review.
• Uphold member rights and health plan obligations per CMS and commercial regs.
• Support documentation and contribute to quality and compliance targets.

Skills

Clinical process outsourcing

Utilization management

Bedside nursing

On-site work

Active Nursing License

Education

BSN degree

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.

Key responsibilities

• 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
• Contribute to the quality and compliance targets of the payer program

About you

• 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
• 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