Utilization Nurse: Clinical Reviews & Care Management

Global Recruitment and Consultancy OPC; Metro Manila; On-site; PHP 1,339,000 - 2,009,000; Full time

Benefits offered by this job

Signing bonus

Job summary

Global Recruitment and Consultancy OPC is seeking a US Registered Nurse (USRN) with Utilization Management or Utilization Review experience to join our healthcare operations team in the Philippines.

The role involves reviewing medical records, assessing clinical information, preparing case documentation, and supporting appropriate utilization decisions, with a signing bonus up to ₱200,000 for qualified candidates.

Qualifications

• Active and unrestricted US RN license.
• At least 3 months/480 hours of direct patient-care RN experience.
• Minimum 3 months of Utilization Management or Utilization Review experience.
• Strong English communication and clinical documentation skills.
• Good analytical skills and computer proficiency.

Responsibilities

• Review medical records and clinical documentation for assigned cases.
• Assess cases based on established clinical guidelines and review criteria.
• Prepare accurate clinical summaries and document review findings.
• Identify missing information and coordinate necessary follow-ups.
• Support medical-necessity, utilization, and care-management reviews.
• Communicate case findings with clinical teams and medical directors.
• Meet required quality and turnaround-time standards while maintaining patient confidentiality.

Skills

Clinical documentation

Analytical skills

Communication skills

Attention to detail

Education

US Registered Nurse license

Tools

EMR systems

ICD-9/10 CPT knowledge

Job description

Global Recruitment and Consultancy OPC is seeking a US Registered Nurse (USRN) with Utilization Management or Utilization Review experience to join our healthcare operations team in the Philippines.

The role involves reviewing medical records, assessing clinical information, preparing case documentation, and supporting appropriate utilization decisions, with a signing bonus up to ₱200,000 for qualified candidates.