Registered Nurse | PHRN | Utilization Review (WFH)

Private Advertiser; Muntinlupa; Remote; PHP 446,000 - 781,000; Full time

Job summary

Private Advertiser is seeking Philippine Registered Nurses (PHRNs) to join our team as Utilization Review Nurses. This role is WFH after regularization with initial training in Alabang, requiring strong clinical knowledge and attention to detail.

You will review medical records, determine medical necessity, and ensure compliant documentation while meeting productivity and quality targets. Night shifts, weekends, and shifting schedules may apply.

Qualifications

• Active Philippine Registered Nurse (PHRN) license.
• Acute hospital bedside experience.
• Experience in healthcare BPO (insurance, denials & appeals, utilization review, etc.) is an advantage.

Responsibilities

• Review medical records and patient information to determine medical necessity and appropriateness of services.
• Conduct utilization reviews based on clinical guidelines and payer requirements.
• Assess inpatient and outpatient cases for level of care, length of stay, and utilization of services.
• Collaborate with physicians, case managers, hospitals and other health professionals.
• Identify gaps in documentation and request additional clinical information as needed.
• Ensure accurate and timely documentation of utilization review decisions.
• Maintain compliance with policies and healthcare regulations.
• Meet productivity, quality, and turnaround-time standards.
• Protect patient confidentiality and comply with privacy regulations.

Skills

PHRN license

Clinical terminology

Documentation accuracy

Analytical thinking

Tools

EMR systems

Job description

WFH AFTER REGULARIZATION!

We are looking for Philippine Registered Nurses (PHRNs) to join our team as Utilization Review Nurses. If you have strong clinical knowledge, excellent attention to detail, and experience working with medical records and healthcare documentation, we’d love to hear from you!

What You'll Do

• Review medical records, clinical documentation, and patient information to determine medical necessity and appropriateness of services.

• Conduct utilization reviews based on established clinical guidelines and payer requirements.

• Assess inpatient and outpatient cases for level of care, length of stay, and appropriate utilization of healthcare services.

• Collaborate with physicians, case managers, hospitals, and other healthcare professionals as needed.

• Identify potential gaps in documentation and request additional clinical information when necessary.

• Ensure accurate and timely documentation of utilization review decisions.

• Maintain compliance with company policies, healthcare regulations, and client requirements.

• Meet established productivity, quality, and turnaround-time standards.

• Protect patient confidentiality and comply with applicable privacy regulations.

Qualifications

• Active Philippine Registered Nurse (PHRN) license.

• Must have Acute hospital Bedside experience

• Experience in a healthcare BPO (Insurance, Denials & Appeals, Utilization Review, Prior Authorization, Medical Coding, etc.) is an advantage but not required.

• Strong understanding of medical terminology, clinical documentation, and healthcare processes.

• Excellent written and verbal communication skills.

• Strong analytical, organizational, and decision-making skills.

• Detail-oriented and able to work independently.

• Willing to work on night shifts, weekends, holidays, and/or shifting schedules as required.

• Willing to report in Alabang during Training period