RN Clinical Auditor: Utilization & Bill Review

Our Clients; Taguig; On-site; PHP 4,397,000 - 7,538,000; Full time

Job summary

Our Clients is seeking a highly skilled US Registered Nurse (USRN) to support clinical review, nurse auditing, utilization review, and medical bill review activities. The role requires strong clinical judgment and the ability to assess medical records, treatment plans, and healthcare services against established guidelines.

Ideal candidates have recent surgical hospital experience or clinical case management experience, with hands-on nurse auditing and review expertise.

Qualifications

• Active US nursing license (USRN) required.
• At least 2 years of recent surgical or clinical case management experience.
• Experience in nurse auditing, utilization review, and medical bill review.
• Ability to interpret medical records and apply clinical guidelines.

Responsibilities

• Conduct clinical review of medical records, treatment plans, and services to assess medical necessity.
• Perform nurse auditing, utilization review, and medical bill review daily.
• Identify discrepancies, overutilization, and billing concerns in medical documentation.
• Collaborate with physicians, nurses, case managers, and claims professionals.
• Ensure documentation of findings and recommendations for decisions.
• Meet productivity, quality, turnaround time, and accuracy targets.
• Stay updated on clinical guidelines and utilization standards.

Skills

USRN

Clinical judgment

Attention to detail

Communication skills

Independent work

Cross-functional collaboration

Education

US RN license

Job description

Our Clients is seeking a highly skilled US Registered Nurse (USRN) to support clinical review, nurse auditing, utilization review, and medical bill review activities. The role requires strong clinical judgment and the ability to assess medical records, treatment plans, and healthcare services against established guidelines.

Ideal candidates have recent surgical hospital experience or clinical case management experience, with hands-on nurse auditing and review expertise.