Utilization Management Nurse

Global Recruitment and Consultancy OPC; Metro Manila; Vor Ort; PHP 1.339.000 - 2.009.000; Vollzeit

Benefits dieser Stelle

Signing bonus

Zusammenfassung

Global Recruitment and Consultancy OPC is seeking a US Registered Nurse (USRN) with Utilization Management or Utilization Review experience to join our healthcare operations team in the Philippines.

The role involves reviewing medical records, assessing clinical information, preparing case documentation, and supporting appropriate utilization decisions, with a signing bonus up to ₱200,000 for qualified candidates.

Qualifikationen

• 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.

Aufgaben

• 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.

Kenntnisse

Clinical documentation

Analytical skills

Communication skills

Attention to detail

Ausbildung

US Registered Nurse license

Tools

EMR systems

ICD-9/10 CPT knowledge

Jobbeschreibung

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.

Preferred: Experience in clinical appeals, claims review, healthcare audit, insurance, care management, healthcare BPO, QA, training, Team Lead/SME roles, or familiarity with ICD-9, ICD-10, or CPT codes.