Utilization Management RN — Impactful Care Leader (Taguig)

Cognizant; Taguig; On-site; PHP 700,000 - 1,200,000; Full time

Benefits offered by this job

Growth opportunities

Collaborative culture

Impactful global work

Job summary

Cognizant is seeking USRN Utilization Management Nurses in Taguig to conduct UM reviews for inpatient and outpatient services, coordinate with physicians, and ensure compliance with regulatory standards.

You will document cases, respond to inquiries, and support quality and HIPAA requirements while contributing to service excellence and positive patient outcomes. Active PHRN and USRN licenses required; mainland US license preferred; onsite work in Taguig.

Qualifications

• Active PHRN and USRN licenses.
• US Mainland license preferred.
• With Utilization Management experience.
• Excellent verbal and written communication skills.
• Comfortable handling voice-based healthcare processes.
• Willing to work onsite in Taguig.

Responsibilities

• Conduct utilization management reviews for inpatient and outpatient services, medications, and treatment requests.
• Evaluate medical necessity and refer cases needing physician review.
• Ensure compliance with URAC, client policies and turnaround times.
• Coordinate with physicians and stakeholders to facilitate timely determinations.
• Maintain accurate documentation in UM systems.
• Communicate UM determinations to members, providers, and stakeholders.
• Support quality, compliance and HIPAA requirements.
• Collaborate with healthcare and operations teams to improve processes.

Skills

PHRN license

USRN license

Utilization Management experience

Verbal & written communication

Voice-based processes

Job description

Cognizant is seeking USRN Utilization Management Nurses in Taguig to conduct UM reviews for inpatient and outpatient services, coordinate with physicians, and ensure compliance with regulatory standards.

You will document cases, respond to inquiries, and support quality and HIPAA requirements while contributing to service excellence and positive patient outcomes. Active PHRN and USRN licenses required; mainland US license preferred; onsite work in Taguig.