US UM Nurse (UK RN) — Utilization Management

Genfinity Philippines, Inc.; Makati; On-site; PHP 600,000 - 900,000; Full time

Job summary

Genfinity Philippines, Inc. seeks a USRN to join our utilization management team at our Makati site. The role focuses on promoting quality medical care through timely, cost-effective evaluation of medical necessity and treatment adequacy.

You will gather data, review ICD-10 coding, communicate with providers and adjusters, and produce management reports. On-site work in Makati is required to support our US-based client and ensure compliance with UR processes.

Qualifications

• Active nursing license in the Philippines and in the mainland US.
• 1 year of experience in Utilization Management/Review.
• Knowledge of ICD-10 codes and utilization review process.
• Strong verbal and written communication, organizational and leadership abilities.
• Proficiency in MS Word and Excel; general computer literacy with dual screens.

Responsibilities

• Facilitate verbal and written communication with employees, employers, providers, and adjusters.
• Gather medical data to evaluate necessity of treatment and functional capabilities.
• Ensure timely processing of billings, utilization issues, and referrals.
• Review admissions and refer cases to peer advisor when standards aren't met.
• Provide reports to management reflecting activities and results.

Skills

Communication

Leadership

Analytical skills

Time management

Interpersonal skills

Organizational skills

Report writing

Tools

MS Word

Excel

Job description

Genfinity Philippines, Inc. seeks a USRN to join our utilization management team at our Makati site. The role focuses on promoting quality medical care through timely, cost-effective evaluation of medical necessity and treatment adequacy.

You will gather data, review ICD-10 coding, communicate with providers and adjusters, and produce management reports. On-site work in Makati is required to support our US-based client and ensure compliance with UR processes.