US Registered Nurse – Utilization Review & Bill Audit

Our Clients; Taguig; On-site; PHP 2,261,000 - 3,769,000; Full time

Job summary

Our Clients seeks a highly skilled US Registered Nurse to support clinical review, nurse auditing, utilization review, and medical bill review. You will assess medical records and treatment plans against established guidelines, with emphasis on surgical cases and case management experience.

The role involves collaboration with physicians, nurses, and claims professionals, reviewing documentation for accuracy and compliance, and supporting complex reviews as needed.

Qualifications

• Must hold an active US Registered Nurse license.
• Minimum 2 years of recent surgical hospital or clinical case management experience.
• Experience in complex medical, legal, and consultation review is preferred.
• Daily application of nurse auditing, utilization review, and medical bill review is required.

Responsibilities

• Conduct clinical review and analysis of medical records to determine medical necessity and compliance.
• Perform nurse auditing, utilization review, and medical bill review daily.
• Identify discrepancies, potential overutilization, and billing concerns.
• Collaborate with physicians, nurses, and other stakeholders.
• Maintain documentation of findings and decisions.
• Support complex reviews when applicable.
• Meet productivity, quality, and turnaround targets with accuracy.

Skills

USRN

Nurse auditing

Utilization review

Medical records review

Clinical assessment

Healthcare compliance

Communication skills

Night shifts

Education

US nursing license (RN)

Job description

Our Clients seeks a highly skilled US Registered Nurse to support clinical review, nurse auditing, utilization review, and medical bill review. You will assess medical records and treatment plans against established guidelines, with emphasis on surgical cases and case management experience.

The role involves collaboration with physicians, nurses, and claims professionals, reviewing documentation for accuracy and compliance, and supporting complex reviews as needed.