Utilization Management RN — Global Impact & Growth

Cognizant Technology Solutions Philippines Inc.

Taguig

In loco

PHP 350.000 - 550.000

Tempo pieno

2 giorni fa

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Descrizione del lavoro

Cognizant Technology Solutions Philippines Inc. is seeking USRN Utilization Management Nurses to support clinical reviews and drive patient outcomes. You will assess medical necessity, refer cases to physician reviewers, coordinate with providers, and document determinations while upholding HIPAA and client standards.

Ideal candidates hold BS Nursing, active PHRN and USRN licenses, plus UM experience. US Mainland license is preferred.

Competenze

BS Nursing degree is required.
Active PHRN and USRN licenses.
US Mainland license preferred.
Utilization Management experience.
Excellent verbal and written communication skills.
Onsite work in Taguig.

Mansioni

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.