Utilization Management Nurse — Dayshift (Taguig Onsite)

Cognizant Technology Solutions Philippines Inc.; Taguig; Presencial; PHP 650.000 - 900.000; Tempo integral

Benefícios oferecidos por esta vaga

Joining bonus

iPhone 18 Pro Max promo

Resumo da vaga

Cognizant Technology Solutions Philippines Inc. is seeking highly qualified USRN Utilization Management Nurses to deliver quality healthcare support and drive positive patient outcomes.

The role involves conducting UM reviews for inpatient/outpatient services, ensuring medical necessity, and maintaining HIPAA-compliant documentation. The incumbent will coordinate with physicians and stakeholders to facilitate timely determinations, adhere to URAC/client policies, and maintain accurate records

Qualificações

• BS Nursing graduate
• 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
• Must be willing to work on a Dayshift schedule

Responsabilidades

• 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.

Conhecimentos

Excellent communication

Voice-based care

Team collaboration

Formação

BS Nursing degree

Ferramentas

Utilization Management software

Descrição da vaga

Cognizant Technology Solutions Philippines Inc. is seeking highly qualified USRN Utilization Management Nurses to deliver quality healthcare support and drive positive patient outcomes.

The role involves conducting UM reviews for inpatient/outpatient services, ensuring medical necessity, and maintaining HIPAA-compliant documentation. The incumbent will coordinate with physicians and stakeholders to facilitate timely determinations, adhere to URAC/client policies, and maintain accurate records