Utilization Management Nurse - Dayshift (Onsite, Taguig)

Cognizant; Taguig; On-site; PHP 600,000 - 800,000; Full time

Benefits offered by this job

Growth opportunities

Support that empowers

Impact that inspires

Job summary

Cognizant invites experienced USRN Utilization Management Nurses to join a global healthcare leader in Taguig. You will conduct utilization management reviews for inpatient and outpatient services, evaluate medical necessity, and coordinate with physicians to determine timely outcomes.

You will maintain documentation, ensure HIPAA compliance, and support quality and customer service goals while safeguarding patient information.

Qualifications

• Active PHRN and USRN licenses are required.
• Experience in Utilization Management.
• Excellent verbal and written communication skills.
• Comfortable handling voice-based healthcare processes.
• Willing to work onsite in Taguig and on a dayshift schedule.

Responsibilities

• Conduct utilization management reviews for inpatient and outpatient services, medications, and treatment requests per 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 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 manner.
• Support quality, compliance, and customer service objectives while safeguarding patient information and HIPAA requirements.
• Collaborate with healthcare and operations teams to improve processes and drive positive patient outcomes.

Skills

Utilization Management experience

Verbal & written communication

Voice-based care processes

Onsite in Taguig

Dayshift schedule

Education

Active PHRN license

USRN license

Job description

Cognizant invites experienced USRN Utilization Management Nurses to join a global healthcare leader in Taguig. You will conduct utilization management reviews for inpatient and outpatient services, evaluate medical necessity, and coordinate with physicians to determine timely outcomes.

You will maintain documentation, ensure HIPAA compliance, and support quality and customer service goals while safeguarding patient information.