RN Utilization Review Specialist — Night Shift

Our Clients; Cebu City; On-site; PHP 600,000 - 900,000; Full time

Job summary

Our Clients in the Philippines is seeking a USRN Utilization Review Specialist to review clinical information, medical records, and patient cases to determine medical necessity, appropriateness, and level of care according to clinical guidelines and payer requirements.

Key responsibilities include inpatient/outpatient utilization reviews, applying InterQual/MCG criteria, determining level of care and length of stay, and communicating decisions to care teams.

Qualifications

• Must be a Registered Nurse in the Philippines.
• Preferred with a valid and active USRN license.
• 2–3 years of clinical experience in hospital, utilization management, or related settings.
• Experience in US healthcare, health insurance, or clinical documentation is an advantage.
• Familiarity with InterQual, MCG, or other utilization management guidelines.

Responsibilities

• Conduct utilization review of inpatient and/or outpatient cases to determine medical necessity.
• Review medical records, clinical documentation, and treatment plans.
• Apply InterQual, MCG, or other payer-specific criteria.
• Determine the level of care, length of stay, and continued stay.
• Collaborate with physicians, nurses, case managers, and other healthcare professionals.

Skills

Clinical assessment

Critical thinking

Verbal & written English

Attention to detail

Documentation

Night shift readiness

Onsite work

Education

Registered Nurse in the Philippines

USRN license

Tools

EMR systems

Job description

Our Clients in the Philippines is seeking a USRN Utilization Review Specialist to review clinical information, medical records, and patient cases to determine medical necessity, appropriateness, and level of care according to clinical guidelines and payer requirements.

Key responsibilities include inpatient/outpatient utilization reviews, applying InterQual/MCG criteria, determining level of care and length of stay, and communicating decisions to care teams.