USRN UMR | 2+ Years UMR Experience | WFH After Training | Cebu Residents Only

EPSILON GROUP SERVICES INC.; Cebu City; Remote; PHP 725,000 - 1,004,000; Full time

Job summary

EPSILON GROUP SERVICES INC. in Cebu is seeking an experienced USRN UMR Specialist for Utilization Management. The role involves reviewing medical records to determine medical necessity and authorization requirements using InterQual/MCG criteria.

The position requires 2+ years UMR/UR experience, active USRN and PHRN licenses, and willingness to undergo mandatory onsite training in Cebu with a transition to Work From Home after training completion.

Qualifications

• 2+ years of UMR/UR experience.
• Experience with InterQual or MCG criteria.
• Hands-on utilization review experience.

Responsibilities

• Conduct utilization and medical necessity reviews.
• Review inpatient admission requests and clinical documentation.
• Apply InterQual or MCG criteria to clinical cases.
• Determine appropriate level of care (inpatient vs observation).
• Review medical records and supporting clinical information.
• Identify missing or insufficient clinical documentation.
• Evaluate clinical facts and evidence to support authorization decisions.
• Communicate review findings to relevant stakeholders.
• Maintain accurate documentation of utilization reviews.
• Follow established clinical, quality, and compliance standards.

Skills

UMR/UR experience

InterQual/MCG criteria

Utilization Review

Inpatient admission review

Level of care review

Education

BS Nursing

Job description

USRN UMR | 2+ Years UMR Experience | InterQual or MCG Required | WFH After Training | Cebu Residents Only

Work Location: Cebu
Work Setup: WFH after successful completion of onsite training
Training: Mandatory onsite training in Cebu
Shift: Night Shift
Start Date: ASAP
Salary Package: ₱65,000–₱90,000
Industry: Healthcare BPO
Employment Type: Full-time

STRICT REQUIREMENTS

• Must be currently residing in Cebu – STRICT REQUIREMENT

• Active USRN license

• Active PHRN license

• BS Nursing graduate

• 2+ years of Utilization Management / Utilization Review (UMR/UR) experience

• Experience conducting Utilization Review

• InterQual or MCG criteria experience – REQUIRED

• Experience with inpatient admission review and level-of-care determination

• Strong knowledge of clinical documentation and medical necessity review

• Strong clinical assessment and analytical skills

• Willing to undergo mandatory onsite training in Cebu

• Must be willing to transition to WFH after successful completion of training

ABOUT THE ROLE

We are looking for an experienced USRN UMR Specialist with strong Utilization Management/Utilization Review experience.

The successful candidate will review medical records and clinical information to determine medical necessity, appropriate level of care, and authorization requirements using evidence-based criteria such as InterQual or MCG.

KEY RESPONSIBILITIES

• Conduct utilization and medical necessity reviews

• Review inpatient admission requests and clinical documentation

• Apply InterQual or MCG criteria to clinical cases

• Determine appropriate level of care, including inpatient versus observation

• Review medical records and supporting clinical information

• Identify missing or insufficient clinical documentation

• Evaluate clinical facts and evidence to support authorization decisions

• Communicate review findings and requirements to relevant stakeholders

• Maintain accurate and complete documentation of utilization reviews

• Follow established clinical, quality, and compliance standards

REQUIRED EXPERIENCE

2+ Years UMR/UR Experience

Candidates should have hands‑on experience in areas such as:

• Utilization Review

• Utilization Management

• Medical Necessity Review

• Inpatient Admission Review

• Level of Care Review

• InterQual or MCG Criteria

WORK SETUP

Mandatory Onsite Training in Cebu WFH After Successful Training

Candidates must be willing to report onsite in Cebu during the required training period. After successfully completing training and meeting performance requirements, the position will transition to Work From Home.

IMPORTANT

Cebu Residents Only

Applicants must currently reside in Cebu and be willing to complete the mandatory onsite training requirement.