US Registered Nurse | Utilization Management & Case Review | ₱100K Bonus

Cognizant Technology Solutions Philippines Inc.; Taguig; On-site; PHP 350,000 - 550,000; Full time

Benefits offered by this job

100K Joining Bonus

iPhone promo

Job summary

Cognizant Technology Solutions Philippines Inc. is seeking USRN Utilization Management Nurses to support clinical reviews and drive patient outcomes. You will assess medical necessity, refer cases to physician reviewers, coordinate with providers, and document determinations while upholding HIPAA and client standards.

Ideal candidates hold BS Nursing, active PHRN and USRN licenses, plus UM experience. US Mainland license is preferred.

Qualifications

• BS Nursing degree is required.
• Active PHRN and USRN licenses.
• US Mainland license preferred.
• Utilization Management experience.
• Excellent verbal and written communication skills.
• Onsite work in Taguig.

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

Communication skills

Voice-based processes

Nursing knowledge

Education

BS Nursing degree

PHRN license

USRN license

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

Preferred Background

• Utilization Management (UM)

• Medical Necessity Review

• Case Management

• Clinical Review

AtCognizant,wedon'sjustofferjobs-webuildcareersthatthriveinthedigitalera.

• GrowthThatMatters-Clearcareerpaths,continuouslearning,andopportunitiestomoveintoleadershiporspecializedroles.You'renotjustfillingaseat-you'rebuildingafuture.

• SupportThatEmpowers-Acollaborativeculturewhereyourvoiceisheard,yourideasmatter,andyourwell-beingisprioritizedthroughstrongbenefitsandwork-lifebalance.

• ImpactThatInspires-Workonglobalaccountsthatshapeindustries,influencemillionsofusers,andgiveyouasenseofpurposebeyondthepaycheck.

Qualified hires may get a chance to win an iPhone 18 Pro Max through our FIRST WIN Promo.

100K Joining Bonus*

Terms and conditions apply.*

Yourfuturestartshere-grow,thrive,andmakeanimpactwithCognizant.