USRN Clinical Review Specialist: Evidence-Based Analysis

Sutherland; Philippines; On-site; PHP 600,000 - 900,000; Full time

Job summary

Sutherland in the Philippines is seeking an experienced Registered Nurse to review medical information and claim files, applying evidence-based clinical judgment. The role emphasizes high accuracy, strong communication, and stakeholder collaboration.

The candidate will assess complex cases, maintain up-to-date medical knowledge, and lead discussions with internal teams and external physicians to ensure balanced conclusions.

Qualifications

• Active US Registered Nurse (USRN) license required.
• At least 1 year of clinical nursing experience.
• Behavioral Health experience is preferred.
• Strong clinical assessment and medical information analysis skills.
• Demonstrated ability to apply medical knowledge to complex cases and arrive at balanced, evidence-based conclusions.
• Advanced critical thinking, analytical reasoning, clinical judgment, and decision-making capabilities.
• Strong interpersonal and stakeholder management skills, with the confidence to engage in challenging and sensitive conversations.
• Excellent written and verbal English communication skills.

Responsibilities

• Review and assess medical information and claim files using clinical knowledge and evidence-based practices.
• Analyze and synthesize complex medical information to develop balanced, accurate, and clinically sound conclusions.
• Apply advanced critical thinking, analytical reasoning, clinical judgment, and decision-making skills when evaluating cases.
• Engage in and lead difficult, complex, and high-impact conversations with internal and external stakeholders.
• Constructively challenge information, recommendations, or decisions when necessary while upholding evidence-based clinical rationale.
• Directly engage with stakeholders, including Business/Leave Services, employees/insured members, and Attending Physicians, to obtain, clarify, and validate medical information.
• Provide coaching and guidance to non-medical staff to enhance their understanding of medical concepts and clinical considerations.
• Maintain a high level of productivity while consistently meeting established quality, accuracy, and volume standards.
• Demonstrate a strong sense of urgency, adaptability, and flexibility in managing priorities and changing business requirements.
• Maintain professional certifications and continuously stay informed of new developments, trends, standards, and best practices in the medical field.

Skills

USRN license

Clinical nursing

Behavioral health

Clinical assessment

Medical knowledge

Critical thinking

Stakeholder management

English communication

Job description

Sutherland in the Philippines is seeking an experienced Registered Nurse to review medical information and claim files, applying evidence-based clinical judgment. The role emphasizes high accuracy, strong communication, and stakeholder collaboration.

The candidate will assess complex cases, maintain up-to-date medical knowledge, and lead discussions with internal teams and external physicians to ensure balanced conclusions.