USRN – Utilization Management Specialist (With UMR Experience)

Metacom Business Processing Solutions; Metro Manila; On-site; PHP 391,000 - 725,000; Full time

Job summary

Metacom Business Processing Solutions is seeking a licensed USRN to join our healthcare team in Metro Manila. The ideal candidate will have hands-on experience in utilization management, medical claims review, or clinical assessment, and will contribute to high-quality patient care.

You will work with UMR/UnitedHealthcare processes, maintain clinical documentation accuracy, and communicate effectively with internal teams. Night-shift scheduling is required.

Qualifications

• Active USRN license is required.
• Experience with UMR (UnitedHealthcare) is required.
• Background in utilization management or clinical review is an advantage.
• Strong knowledge of medical terminology and clinical documentation.
• Good communication and analytical skills.
• Willing to work on a nightshift schedule.

Responsibilities

• Utilize management and clinical review to assess cases.
• Review medical claims with emphasis on accuracy and compliance.
• Collaborate with healthcare teams to support patient care.
• Maintain clear and precise clinical documentation.
• Communicate findings effectively to internal stakeholders.

Skills

Utilization management

Medical claims review

Clinical assessment

Medical terminology

Analytical skills

Communication skills

Night shift

Education

Active USRN license

Job description

We are looking for a licensed USRN with experience in UMR (UnitedHealthcare) to join our healthcare team. The ideal candidate should have a background in utilization management, medical claims review, or clinical assessment.

Qualifications:

• Active USRN license.

• Previous UMR experience is required.

• Experience in utilization management or clinical review is an advantage.

• Strong knowledge of medical terminology and clinical documentation.

• Good communication and analytical skills.

• Willing to work on a nightshift schedule.