Senior Clinical Analyst — Utilization & Care Lead

Lancesoft APAC; Makati; Hybrid; PHP 1,339,000 - 1,674,000; Full time

Job summary

Lancesoft APAC in Makati, Philippines seeks a Sr. Clinical Analyst to review and evaluate medical records, providing expert determinations for requested services.

The role supports utilization management across care, disease, quality, and pharmacy management, with clinical education responsibilities. The position requires an Active Physician PRC license and residency in Internal Medicine, Family Medicine, or Medical Sub specialties, plus strong Microsoft Office skills.

Qualifications

• Active Physician PRC license required.
• Completed residency in Internal Medicine, Family Medicine or Medical Subspecialties.
• Proficient with Microsoft Office applications.
• Excellent communication, collaboration, problem-solving and conflict-resolution skills.
• Results-driven with ownership of initiatives and cross-functional teamwork.

Responsibilities

• Review and evaluate submitted medical records to provide expert medical determinations on requested services.
• Perform utilization management activities and contribute to care/disease management, quality, pharmacy management, and clinical education.
• Ensure all clinical decisions align with regulatory, CMS policies and clinical guidelines.
• Act as a clinical escalation resource and collaborate with nursing teams across clinical functions.
• Progress to SME, trainer, and auditor roles for clinical staff and support cross-functional projects.

Skills

Communication

Collaboration

Problem-solving

Conflict resolution

Ownership

Education

Residency: Internal Medicine

Residency: Family Medicine

Residency: Medical Subspecialties

Active Physician PRC license

Tools

Microsoft Office

Job description

Lancesoft APAC in Makati, Philippines seeks a Sr. Clinical Analyst to review and evaluate medical records, providing expert determinations for requested services.

The role supports utilization management across care, disease, quality, and pharmacy management, with clinical education responsibilities. The position requires an Active Physician PRC license and residency in Internal Medicine, Family Medicine, or Medical Sub specialties, plus strong Microsoft Office skills.