USRN UMR Specialist — WFH After Training (Cebu)

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

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.