US Registered Nurse | Utilization Management & Appeals | ₱100K Bonus

Cognizant Technology Solutions Corporation; Taguig; Sur place; PHP 420 000 - 640 000; Plein temps

Résumé du poste

Cognizant Technology Solutions Corporation invites qualified USRN Utilization Management Nurses in the Philippines to join a global healthcare team that delivers quality patient care and results-driven outcomes.

You will perform utilization reviews, evaluate medical necessity, and coordinate with physicians and stakeholders to achieve timely determinations while ensuring HIPAA compliance and patient safety. This role is onsite in Taguig with a dayshift schedule.

Qualifications

• Active PHRN and USRN license.
• US Mainland license 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.

Responsabilités

• 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.

Description du poste

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

• 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

• 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.