Registered Nurse - Utilization Review Nurse (Work from home)

Private Advertiser; Pasay; Remote; PHP 420,000 - 660,000; Full time

Job summary

Private Advertiser in the Philippines is seeking a detail oriented Registered Nurse (RN) to join as a Utilization Review Nurse, working from home. You will review medical records, assess medical necessity, and ensure compliance with clinical guidelines and standards.

This remote role offers flexibility for nurses exploring non-bedside careers while maintaining clinical expertise and professional growth within a compliant framework.

Qualifications

• Must be a Licensed Registered Nurse (RN) in the Philippines.
• Experience in utilization review, case management, or medical records is an advantage.
• Strong clinical assessment and analytical skills.
• Excellent written and verbal communication skills.
• Detail-oriented, organized, and able to work independently.
• Able to work remotely and manage time effectively.

Responsibilities

• Review medical records and clinical documentation to assess medical necessity and appropriateness of healthcare services.
• Evaluate services against established clinical criteria and policies.
• Analyze clinical information to support utilization management decisions.
• Identify missing or inconsistent documentation and coordinate with providers for additional information.
• Ensure timely completion of utilization review assessments and maintain confidentiality.

Skills

Clinical assessment

Analytical skills

Communication skills

Time management

EMR experience

Education

Bachelor of Science in Nursing

Tools

EMR systems

Job description

Job Overview

We are looking for a detail-oriented and motivated Registered Nurse (RN) to join our team as a Utilization Review Nurse. In this role, you will use your clinical knowledge and nursing expertise to review medical records, evaluate the appropriateness and medical necessity of healthcare services, and ensure that patient care meets established clinical guidelines and standards.

This is an excellent opportunity for nurses who want to explore a non-bedside nursing career while enjoying the flexibility and convenience of working from home.

Key Responsibilities

• Review medical records, clinical documentation, and patient histories to assess medical necessity and appropriateness of healthcare services.

• Evaluate healthcare services against established clinical criteria, guidelines, and policies.

• Analyze clinical information to support utilization management and review decisions.

• Identify missing, incomplete, or inconsistent medical documentation.

• Coordinate with healthcare providers, physicians, and other medical professionals when additional clinical information is needed.

• Ensure accurate and timely completion of utilization review assessments.

• Maintain confidentiality and comply with healthcare regulations and data privacy policies.

• Document review findings and recommendations accurately in the designated systems.

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

Qualifications

• Must be a Licensed Registered Nurse (RN) in the Philippines.

• With clinical nursing experience preferred.

• Experience in Utilization Review, Case Management, Clinical Documentation, Medical Records, or Healthcare Insurance is an advantage.

• Strong clinical assessment and analytical skills.

• Excellent written and verbal communication skills.

• Detail-oriented, organized, and capable of working independently.

• Computer literate and comfortable using electronic medical records and online platforms.

• Able to manage time effectively and meet deadlines while working remotely.

• Willing to work on a schedule aligned with business requirements.