USRN Utilization Review Nurse | ₱100K Joining Bonus*

Cognizant; Taguig; Presencial; PHP 600.000 - 900.000; Jornada completa

Descripción de la vacante

Cognizant in Taguig, Philippines is seeking a licensed healthcare professional to handle utilization management reviews for inpatient and outpatient services, medications, and treatment requests according to clinical guidelines. The role includes evaluating medical necessity, referring cases to physician reviewers when needed, and ensuring URAC, client policies, and turnaround-time requirements are met.

You will coordinate with physicians, healthcare providers, and stakeholders to deliver timely

Formación

• Active PHRN and USRN licenses are required.
• US Mainland license holder preferred.
• With Utilization Management experience.
• Excellent verbal and written communication skills.
• Comfortable handling voice-based healthcare processes.
• Willing to work onsite in Taguig.

Responsabilidades

• Conduct utilization management 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.

Conocimientos

Utilization Management

PHRN license

USRN license

Verbal communication

Written communication

HIPAA compliance

On-site work in Taguig

Voice-based processes

US license preferred

Descripción del empleo

• 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

• Active PHRN and USRN license
• US Mainland license holder preferred
• With Utilization Management experience
• Excellent verbal and written communication skills
• Comfortable handling voice-based healthcare processes
• Willing to work onsite in Taguig

Preferred Background

• Medical Necessity Review
• Case Management
• Clinical Review

Why Join Us?

At Cognizant, we don’t just offer jobs—we build careers that thrive in the digital era.

• Growth That Matters – Clear career paths, continuous learning, and opportunities to move into leadership or specialized roles. You’re not just filling a seat—you’re building a future.
• Support That Empowers – A collaborative culture where your voice is heard, your ideas matter, and your well-being is prioritized through strong benefits and work-life balance.
• Impact That Inspires – Work on global accounts that shape industries, influence millions of users, and give you a sense of purpose beyond the paycheck.

Terms and conditions apply. *

Your future starts here—grow, thrive, and make an impact with Cognizant.