USRN Clinical Reviewer: Impactful Utilization Management

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

Benefits offered by this job

Competitive compensation

Comprehensive benefits

Job summary

Sutherland is seeking highly analytical US Registered Nurses (USRNs) to join our healthcare team in Manila. Review complex cases, evaluate supporting documentation, and provide evidence-based recommendations for informed healthcare decisions.

Ideal candidates will have UR/UM experience, strong clinical judgment, and excellent English communication skills. This on-site role offers competitive compensation and comprehensive benefits in a fast-paced environment.

Qualifications

• Active and unrestricted USRN license.
• Minimum 1 year clinical nursing experience in a hospital, healthcare, or related setting.
• Experience in UR/UM/Clinical Review/Case Management/Appeals/Medical Claims Review.
• Strong clinical assessment and medical record review skills.
• Advanced critical thinking, analytical reasoning, and decision-making capabilities.
• Excellent written and verbal English communication skills.
• Ability to engage effectively with physicians, healthcare providers, and cross-functional stakeholders.
• Strong organizational skills with ability to manage multiple priorities and meet targets.

Responsibilities

• Review and evaluate medical records, clinical documentation, and claim-related information to support accurate determinations.
• Analyze complex clinical cases and synthesize medical information into clear, balanced, and well-supported recommendations.
• Apply advanced nursing knowledge, clinical judgment, and critical thinking to assess conditions, treatments, and outcomes.
• Collaborate with internal stakeholders, healthcare providers, and attending physicians to gather, clarify, and validate clinical information.
• Conduct professional discussions regarding complex clinical matters with empathy and professionalism.
• Identify gaps or additional information needed to support clinical decision-making.
• Serve as a trusted clinical resource by guiding non-medical teams on medical terminology and treatment plans.
• Ensure compliance with clinical guidelines, regulatory requirements, and quality standards.
• Meet productivity, quality, accuracy, and SLA expectations in a fast-paced environment.
• Stay current with healthcare trends and nursing standards.

Skills

USRN license

Clinical nursing experience

Analytical reasoning

Decision-making

English communication

Stakeholder engagement

Organizational skills

Job description

Sutherland is seeking highly analytical US Registered Nurses (USRNs) to join our healthcare team in Manila. Review complex cases, evaluate supporting documentation, and provide evidence-based recommendations for informed healthcare decisions.

Ideal candidates will have UR/UM experience, strong clinical judgment, and excellent English communication skills. This on-site role offers competitive compensation and comprehensive benefits in a fast-paced environment.