US RN: Utilization & Case Management (Hybrid)

Gratitude Philippines; Cebu City; Hybrid; PHP 1,004,000 - 1,674,000; Full time

Benefits offered by this job

Sign-on Bonus PHP 100,000

Job summary

Gratitude Philippines is seeking an experienced US Registered Nurse to support the South Carolina account. The role involves clinical review, nurse auditing, utilization review, bill review, and complex medical case management activities.

Candidates must hold an active USRN license and have relevant clinical experience. Onsite training will be provided, with a transition to hybrid/remote work after training.

Qualifications

• Active US Registered Nurse license from any mainland US state.
• Minimum 2 years of recent surgical experience in a hospital setting or 2+ years of clinical case management experience.
• Minimum 2 years of experience in daily nurse auditing, utilization review, and bill review.

Responsibilities

• Perform nurse auditing, utilization review, and medical bill review activities.
• Review and assess clinical cases based on established guidelines and requirements.
• Support complex medical, legal, and consultation reviews.
• Apply clinical knowledge to evaluate medical documentation and case information.
• Review surgical and clinical information accurately and identify relevant medical details.
• Maintain accurate documentation and ensure quality and compliance in all assigned activities.
• Collaborate with internal teams and stakeholders to resolve clinical queries.
• Follow account-specific processes, quality standards, and operational requirements.
• Successfully complete validation, HR interview, hiring manager interview, and onboarding requirements.

Skills

USRN license

Surgical experience

Clinical case management

Nurse auditing

Utilization review

Bill review

Communication skills

Shifting schedules

Job description

Gratitude Philippines is seeking an experienced US Registered Nurse to support the South Carolina account. The role involves clinical review, nurse auditing, utilization review, bill review, and complex medical case management activities.

Candidates must hold an active USRN license and have relevant clinical experience. Onsite training will be provided, with a transition to hybrid/remote work after training.