USRN Clinical Review Specialist

Sutherland; Taguig; Hybride; PHP 446 000 - 781 000; Plein temps

Avantages offerts par ce poste

Growth and advancement opportunities

Performance Based Incentive

HMO after 6 months

Life Insurance upon hiring

Résumé du poste

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.

Responsabilités

• 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.

Connaissances

Clinical experience

Utilization review

USRN License

Formation

US Registered Nurse (USRN) License

Description du poste

USRN – Clinical Claims / Utilization Review

What You'll Do

• Review medical records and claims using your clinical knowledge.
• Assess complex cases and make accurate, 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 and challenging 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.

What We're Looking For

• Active US Registered Nurse (USRN) License
• At least 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

What’s in it for you

• Be part of one of the largest, independent process transformation companies in the world and serve marquee clients in major industry verticals
• Growth and advancement opportunities
• Performance Based Incentive
• HMO after 6 months
• Life Insurance upon hiring