USRN Clinical Claims & Utilization Review Specialist Hybrid

Sutherland; Taguig; Hybrid; PHP 446,000 - 781,000; Full time

Benefits offered by this job

Growth and advancement opportunities

Performance Based Incentive

HMO after 6 months

Life Insurance upon hiring

Job summary

Sutherland in Taguig, Philippines, seeks a US-Registered Nurse to support clinical claims and utilization review processes. You will review medical records, assess complex cases, and provide clear clinical conclusions.

The role requires an active USRN license, 1–2 years of clinical/hospital bedside experience, and at least 1 year in clinical claims/UR. Hybrid work setup in BGC, Taguig offered.

Qualifications

• Active US Registered Nurse (USRN) license.
• 1–2 years of clinical/hospital/bedside experience.
• At least 1 year of clinical claims / utilization review experience.
• Willing to work on a hybrid setup in BGC, Taguig.

Responsibilities

• Review medical records and claims using clinical knowledge.
• Assess complex cases and make evidence-based decisions.
• Analyze medical information and provide clear clinical conclusions.
• Communicate with employees, patients/members, doctors, and internal teams to clarify medical information.
• Handle sensitive conversations professionally.
• Provide guidance to non-medical teams on clinical matters.
• Ensure accuracy, quality, and productivity in handling cases.
• Stay updated on medical standards, practices, and industry developments.

Skills

Clinical experience

Utilization review

USRN License

Education

US Registered Nurse (USRN) License

Job description

Sutherland in Taguig, Philippines, seeks a US-Registered Nurse to support clinical claims and utilization review processes. You will review medical records, assess complex cases, and provide clear clinical conclusions.

The role requires an active USRN license, 1–2 years of clinical/hospital bedside experience, and at least 1 year in clinical claims/UR. Hybrid work setup in BGC, Taguig offered.