Utilization Management Nurse: Clinical Reviews & Compliance

Concentrix Philippines; Quezon City; On-site; PHP 391,000 - 614,000; Full time

Benefits offered by this job

HMO coverage

Life insurance

Paid training

Education/licensure assistance

Partner discounts

Referral bonuses

Performance incentives

Night shift differential

Mental wellness programs

Job summary

Concentrix Philippines is seeking a Utilization Management (UM) PHRN to review, process, and resolve UM cases. The role ensures timely and clinically sound UM review while upholding member rights and health plan obligations under commercial and CMS regulations.

The successful candidate will support case documentation and contribute to the quality and compliance targets of the payer program, with on-site work at Bridgetowne, Quezon City.

Qualifications

• BSN degree required.
• Active nursing license required.
• At least six (6) months background in clinical process outsourcing and clinical role handling utilization management (BPO).
• At least 6 months bedside experience.

Responsibilities

• Review, processing, and resolution of UM cases.
• Ensure timely and clinically sound UM review.
• Uphold member rights and health plan obligations under commercial and CMS regulations.
• Support case documentation.
• Contribute to the quality and compliance targets of the payer program.

Skills

BSN

Active Nursing License

Clinical process outsourcing

Utilization management

Bedside experience

Education

BSN degree

Job description

Concentrix Philippines is seeking a Utilization Management (UM) PHRN to review, process, and resolve UM cases. The role ensures timely and clinically sound UM review while upholding member rights and health plan obligations under commercial and CMS regulations.

The successful candidate will support case documentation and contribute to the quality and compliance targets of the payer program, with on-site work at Bridgetowne, Quezon City.