RN Leader: Utilization Review & Care Coordination

Health Business Solutions LLC; Manila; On-site; PHP 900,000 - 1,500,000; Full time

Job summary

Health Business Solutions LLC is seeking a Manager, Utilization Review to oversee daily operations of Utilization Review and lead a team of Utilization Review Nurses. The role focuses on care coordination, cost management, and maintaining high patient care standards.

You will supervise and mentor the UR nursing team, develop individualized care plans, monitor utilization, and drive quality improvement while ensuring regulatory compliance.

Qualifications

• Current RN license; PHRN/USRN preferred.
• BSN required; MSN preferred.
• Minimum 2 years leadership in case management or care coordination.
• Strong clinical assessment and critical thinking.
• Excellent communication and interpersonal skills.
• Knowledge of healthcare regulations, insurance processes, and quality improvement.
• Proficiency with EHR and healthcare software.
• Commitment to patient-centered, ethical practice.

Responsibilities

• Lead and mentor Utilization Review Nurses.
• Oversee care plan development and coordination.
• Monitor resource utilization and care appropriateness.
• Implement quality improvement initiatives.
• Manage department budget and resources.
• Provide ongoing staff training and development.
• Serve as patient advocate throughout care.
• Ensure timely documentation and regulatory compliance.

Skills

Leadership

Team Management

Care Coordination

Quality Improvement

Budgeting

Staff Development

Patient Advocacy

Documentation

Education

BSN

MSN

Tools

EHR systems

Healthcare software

Job description

Health Business Solutions LLC is seeking a Manager, Utilization Review to oversee daily operations of Utilization Review and lead a team of Utilization Review Nurses. The role focuses on care coordination, cost management, and maintaining high patient care standards.

You will supervise and mentor the UR nursing team, develop individualized care plans, monitor utilization, and drive quality improvement while ensuring regulatory compliance.