US Registered Nurse Utilization Management And Appeals ₱100K Bonus

Cognizant Technology Solutions Corporation; Taguig; On-site; PHP 420,000 - 720,000; Full time

Job summary

Cognizant Technology Solutions Corporation in Taguig seeks highly qualified USRN Utilization Management Nurses to deliver quality healthcare support and drive patient outcomes. This on-site role requires a BS Nursing degree, active PHRN and USRN licenses, and preferred US Mainland licensure.

You will conduct UM reviews, evaluate medical necessity, coordinate with physicians, and ensure regulatory compliance while protecting patient information under HIPAA.

Qualifications

• BS Nursing graduate.
• Active PHRN and USRN license.
• US Mainland license holder preferred.
• With Utilization Management experience.
• Excellent verbal and written communication skills.
• Comfortable handling voice-based healthcare processes.
• Willing to work onsite in Taguig.
• Must be willing to work on a Dayshift schedule.

Responsibilities

• Conduct utilization management (UM) reviews for inpatient and outpatient services, medications, and treatment requests based on clinical guidelines and client requirements.
• Evaluate medical necessity and refer cases requiring further review to physician reviewers.
• Ensure compliance with regulatory standards, URAC guidelines, client policies, and established turnaround times.
• Coordinate with physicians, healthcare providers, and stakeholders to facilitate timely review outcomes and determinations.
• Maintain accurate documentation and case records within utilization management systems.
• Communicate UM determinations and respond to member, provider, and stakeholder inquiries in a professional and timely manner.
• Support quality, compliance, and customer service objectives while safeguarding patient information and HIPAA requirements.
• Collaborate with healthcare and operations teams to improve processes, ensure service excellence, and drive positive patient outcomes.

Skills

UM experience

Communication skills

Voice-based processes

Onsite work

HIPAA compliance

Education

BS Nursing

PHRN License

USRN License

Job description

Job Description:

Advance Your Nursing Career with a Global Healthcare Leader

We are seeking highly qualified USRN Utilization Management Nurses who are passionate about delivering quality healthcare support and driving positive patient outcomes. Join a global organization that empowers healthcare professionals through innovation, collaboration, and continuous career development.

Job Summary

• Conduct utilization management (UM) reviews for inpatient and outpatient services, medications, and treatment requests based on clinical guidelines and client requirements.
• Evaluate medical necessity and refer cases requiring further review to physician reviewers.
• Ensure compliance with regulatory standards, URAC guidelines, client policies, and established turnaround times.
• Coordinate with physicians, healthcare providers, and stakeholders to facilitate timely review outcomes and determinations.
• Maintain accurate documentation and case records within utilization management systems.
• Communicate UM determinations and respond to member, provider, and stakeholder inquiries in a professional and timely manner.
• Support quality, compliance, and customer service objectives while safeguarding patient information and HIPAA requirements.
• Collaborate with healthcare and operations teams to improve processes, ensure service excellence, and drive positive patient outcomes.

Qualifications

• BS Nursing graduate
• Active PHRN and USRN license
• US Mainland license holder preferred
• With Utilization Management experience
• Excellent verbal and written communication skills
• Comfortable handling voice-based healthcare processes
• Willing to work onsite in Taguig
• Must be willing to work on a Dayshift schedule

Preferred Background

• Utilization Management (UM)
• Medical Necessity Review
• Case Management
• Clinical Review

At Cognizant, we don’t just offer jobs—we build careers that thrive in the digital era.

• Growth That Matters – Clear career paths, continuous learning, and opportunities to move into leadership or specialized roles. You’re not just filling a seat—you’re building a future.
• Support That Empowers – A collaborative culture where your voice is heard, your ideas matter, and your well-being is prioritized through strong benefits and work-life balance.
• Impact That Inspires – Work on global accounts that shape industries, influence millions of users, and give you a sense of purpose beyond the paycheck.

Your future starts here—grow, thrive, and make an impact with Cognizant.

Requirements: