Remote PHRN Utilization Review Nurse – Night Shifts

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

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.