USRN Utilization Management & Appeals | ₱100K Joining Bonus

Cognizant Technology Solutions Philippines Inc.; Taguig; Vor Ort; PHP 600.000 - 800.000; Vollzeit

Zusammenfassung

Cognizant Technology Solutions Philippines Inc. is seeking USRN Utilization Management Nurses to deliver high-quality healthcare support and drive patient outcomes.

You will conduct UM reviews for inpatient and outpatient services, evaluate medical necessity, and ensure compliance with URAC, client policies, and turnaround times. Qualified candidates hold a BS Nursing degree, active PHRN and USRN licenses (US Mainland license preferred), and are willing to work onsite in Taguig on a dayshift

Qualifikationen

• BS Nursing degree is required.
• Active PHRN and USRN licenses.
• US Mainland license holders are preferred.
• Experience in Utilization Management/Appeals.
• Excellent verbal and written communication skills.
• Comfortable handling voice-based healthcare processes.
• Willing to work onsite in Taguig.
• Dayshift schedule is required.

Aufgaben

• Perform UM reviews for inpatient and outpatient services, medications, and treatments.
• Evaluate medical necessity and refer cases to physician reviewers when needed.
• Ensure compliance with URAC guidelines, client policies, and established turnaround times.
• Coordinate with physicians, healthcare providers, and stakeholders to facilitate timely determinations.
• Maintain accurate documentation and case records in UM systems.
• Communicate UM determinations to members, providers, and stakeholders professionally.
• Protect patient information in line with HIPAA requirements.
• Collaborate with healthcare and operations teams to improve processes and service quality.

Kenntnisse

Utilization Management

Communication skills

Voice-based processes

Dayshift readiness

Ausbildung

BS Nursing degree

PHRN license

USRN license

US Mainland license preferred

Jobbeschreibung

Advance Your Nursing Career with a Global Healthcare Leader

We are seeking highly qualified USRN Utilization Management Nurses who are passionate about delivering quality healthcare support and driving positive patient outcomes. Join a global organization that empowers healthcare professionals through innovation, collaboration, and continuous career development.

Job Summary

• Conduct utilization management (UM) reviews for inpatient and outpatient services, medications, and treatment requests based on clinical guidelines and client requirements.

• Evaluate medical necessity and refer cases requiring further review to physician reviewers.

• Ensure compliance with regulatory standards, URAC guidelines, client policies, and established turnaround times.

• Coordinate with physicians, healthcare providers, and stakeholders to facilitate timely review outcomes and determinations.

• Maintain accurate documentation and case records within utilization management systems.

• Communicate UM determinations and respond to member, provider, and stakeholder inquiries in a professional and timely manner.

• Support quality, compliance, and customer service objectives while safeguarding patient information and HIPAA requirements.

• Collaborate with healthcare and operations teams to improve processes, ensure service excellence, and drive positive patient outcomes.

Qualifications

• BS Nursing graduate

• Active PHRN and USRN license

• US Mainland license holder preferred

• With Utilization Management/Appeals experience

• Excellent verbal and written communication skills

• Comfortable handling voice-based healthcare processes

• Willing to work onsite in Taguig

• Must be willing to work on a Dayshift schedule

Preferred Background

• Utilization Management (UM)

• Medical Necessity Review

• Case Management

• Clinical Review

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• GrowthThatMatters–Clearcareerpaths,continuouslearning,andopportunitiestomoveintoleadershiporspecializedroles.You’renotjustfillingaseat—you’rebuildingafuture.

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• ImpactThatInspires–Workonglobalaccountsthatshapeindustries,influencemillionsofusers,andgiveyouasenseofpurposebeyondthepaycheck.

Qualified hires may get a chance to win an iPhone 18 Pro Max through our FIRST WIN Promo.

100K Joining Bonus*

Terms and conditions apply.*

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