Utilization Management Senior Analyst - US RN

Bravissimo Resourcing Inc.; Taguig; On-site; PHP 223,200 - 390,600; Full time

Job summary

A healthcare staffing company in Metro Manila seeks a skilled Registered Nurse to create appeal records and case summaries for external reviews. The ideal candidate must possess a valid US RN license and at least 3 months of clinical experience in diverse settings including hospitals and clinics. This position requires effective communication for presenting cases and meeting designated turnaround times. The role also welcomes additional leadership experience in team lead or quality assurance roles.

Qualifications

• Must hold current and unrestricted US Registered Nurse license.
• Minimum 3 months clinical experience as a RN.
• Experience in inpatient, outpatient, or community clinic settings required.

Responsibilities

• Creates complete appeal records for external appeal reviews.
• Submits cases and presents summaries to client's Grievance Team.
• Completes assignments within client-designated turnaround times.

Skills

Clinical experience

Patient care

Leadership skills (TL, QA, Trainer)

Education

Bachelor of Science Nursing (BSN)

General Nursing & Midwifery Diploma

Associate Nursing Degree

Job description

Responsibilities

• Creates complete appeal records for external appeal reviews, using standardized Independent Review Entity (IRE) forms and including all required documentation.
• Creates a detailed case summary in narrative format for each appeal.
• Submits cases as directed for each applicable geographic region.
• Presents verbal and written case summaries to client’s Grievance Team and client Medical Directors.
• Completes assignments within client-designated turnaround times.

Requirements

• Bachelor of Science Nursing (BSN) degree or General Nursing & Midwifery (GNM) Diploma or Basic Bachelor of Science (BSC) in Nursing degree or Associate Nursing Degree or Nursing Diploma
• Holds current and unrestricted US Registered Nurse license
• 3 months clinical experience (480 hours of working experience as a RN)
• Work experience as an active RN license and providing direct patient care
• Clinical setting includes inpatient hospital, outpatient hospital or community clinic
• No state license required
• For CL 10 role USRN + UM, minimum 6 months of UM experience.
• Work experience such as TL, QA, Trainer and Claims are preferred and good to have skills only