Utilization Management RN – On-Site Makati

genfinity; Makati; On-site; PHP 420,000 - 540,000; Full time

Job summary

Genfinity is seeking a USRN at its Philippines-based Makati site to provide utilization management services for clients, insurers, and injured employees. The role focuses on ensuring timely, cost-effective medical care through data gathering and medical necessity evaluations.

The candidate must hold an active nursing license in the Philippines and the US mainland, with at least one year in utilization management. On-site reporting in Makati is required.

Qualifications

• Active Nursing license in the Philippines and in the mainland US.
• 1 year of experience in Utilization Management/Review.
• Knowledge of ICD-10 codes and utilization review processes.
• Strong verbal and written communication, organizational, and leadership skills.

Responsibilities

• Coordinate verbal and written communication with employees, providers, and adjusters.
• Gather medical data to evaluate necessity of treatment and functional capacity.
• Ensure timely processing of billings, utilization issues, and referrals.
• Review admissions applications and approve or refer to peer advisor when standards fail.
• Produce reports reflecting activities and results for management.

Skills

Utilization Management

ICD-10 knowledge

Verbal & written communication

Leadership

Time management

Analytical thinking

Tools

MS Word

MS Excel

Job description

Genfinity is seeking a USRN at its Philippines-based Makati site to provide utilization management services for clients, insurers, and injured employees. The role focuses on ensuring timely, cost-effective medical care through data gathering and medical necessity evaluations.

The candidate must hold an active nursing license in the Philippines and the US mainland, with at least one year in utilization management. On-site reporting in Makati is required.