Utilization Management Nurse

Global Recruitment and Consultancy OPC; Metro Manila; On-site; PHP 900,000 - 1,300,000; Full time

Job summary

Global Recruitment and Consultancy OPC in the Philippines is seeking a US Registered Nurse (USRN) with Utilization Management experience to join a healthcare-focused operations team. The role involves reviewing medical records, assessing clinical information, preparing case documentation, and supporting utilization decisions.

A signing bonus of up to ₱200,000 may be available to qualified candidates under program requirements.

Qualifications

• Active US RN license required.
• Minimum 3 months direct patient-care RN experience.
• Minimum 3 months Utilization Management/Utilization Review experience.
• Strong English communication and clinical documentation skills.
• Good analytical skills and computer proficiency.

Responsibilities

• Review medical records and clinical documentation for assigned cases.
• Assess cases based on established clinical guidelines and review criteria.
• Prepare accurate clinical summaries and document review findings.
• Identify missing information and coordinate necessary follow-ups.
• Support medical-necessity, utilization, and care-management reviews.
• Communicate case findings with clinical teams and medical directors.
• Meet required quality and turnaround-time standards while maintaining patient confidentiality.

Skills

US RN license

RN experience 3 months

UM/UR experience 3 months

English proficiency

Analytical skills

Computer skills

Job description

We are currently seeking a US Registered Nurse (USRN) with Utilization Management or Utilization Review experience to join a healthcare-focused operations team.

This position is ideal for nurses who want to transition further into a non-clinical, non-bedside career while continuing to utilize their nursing knowledge and clinical judgment. The role involves reviewing medical records, assessing clinical information, preparing case documentation, and supporting appropriate healthcare utilization decisions.

A signing bonus of up to ₱200,000 may be available to qualified candidates, subject to the applicable program requirements and conditions.

Key Responsibilities

• Review medical records and clinical documentation for assigned cases.
• Assess cases based on established clinical guidelines and review criteria.
• Prepare accurate clinical summaries and document review findings.
• Identify missing information and coordinate necessary follow-ups.
• Support medical-necessity, utilization, and care-management reviews.
• Communicate case findings with clinical teams and medical directors.
• Meet required quality and turnaround-time standards while maintaining patient confidentiality.

Qualifications

• Active and unrestricted US RN license.
• At least 3 months/480 hours of direct patient-care RN experience.
• Minimum 3 months of Utilization Management or Utilization Review experience.
• Strong English communication and clinical documentation skills.
• Good analytical skills and computer proficiency.