Utilization Management RN - Clinical Review

Bravissimo Resourcing Inc.; Manila; Remote; PHP 300,000 - 600,000; Full time

Job summary

Bravissimo Resourcing Inc. is seeking a US Registered Nurse (USRN) with Utilization Management experience to evaluate healthcare services, ensure medical necessity, and optimize patient outcomes.

The role involves working with care teams to review guidelines and support safe transitions for patients. The candidate must hold an active US RN license with direct patient care experience and have familiarity with inpatient, outpatient, or community clinic settings.

Qualifications

• Minimum 6 months Utilization Management experience.
• At least 3 months clinical RN experience (480 hours).
• Active, unrestricted US RN license required.
• Clinical setting experience: inpatient, outpatient, or community clinic.

Responsibilities

• Conduct utilization reviews (prospective, concurrent, or retrospective) using clinical guidelines to assess medical necessity and appropriateness of care.
• Collaborate with healthcare providers and interdisciplinary teams to facilitate efficient patient care transitions.
• Ensure strict adherence to US healthcare regulatory standards and client operational protocols.

Skills

Utilization Management

Clinical experience

RN license

Inpatient/outpatient

Job description

Bravissimo Resourcing Inc. is seeking a US Registered Nurse (USRN) with Utilization Management experience to evaluate healthcare services, ensure medical necessity, and optimize patient outcomes.

The role involves working with care teams to review guidelines and support safe transitions for patients. The candidate must hold an active US RN license with direct patient care experience and have familiarity with inpatient, outpatient, or community clinic settings.