Registered Nurse (PHRN) – Utilization Management Role

Concentrix; Quezon City; On-site; PHP 360,000 - 600,000; Full time

Benefits offered by this job

HMO coverage

Life insurance

Leave conversion

Fully paid training

Education/licensure assistance

Exclusive partner discounts

Performance incentives

Night shift differential

Mental wellness programs

Accelerated career pathways

Job summary

Concentrix is seeking a Utilization Management PHRN to review, process, and resolve UM cases, ensuring timely, clinically sound assessments in line with commercial and CMS regulations. The role supports documentation, and contributes to quality and compliance targets of the payer program.

Requirements include BSN, active Philippine RN license, and at least 6 months in clinical process outsourcing with utilization management, plus 6 months bedside experience.

Qualifications

• BSN degree is required.
• Active Philippine RN license required; US RN profiles will not be considered.
• At least 6 months background in clinical process outsourcing and utilization management (BPO)
• At least 6 months bedside nursing experience.

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 quality and compliance targets of the payer program.

Skills

Clinical process outsourcing

Utilization management

Bedside nursing experience

Education

RN license (Philippines)

BSN

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 Philippine RN license required. US RN profiles will not be considered.
• 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 undergo a 6-month onsite training 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