Utilization Review Nurse – Clinical Programs

Crawford-; Manila; On-site; PHP 360,000 - 600,000; Full time

Job summary

Crawford Educational Services in Manila, Philippines seeks a Nursing Utilization Review Specialist to review medical information for necessity and appropriateness. You will collaborate with physicians to resolve cases and document findings in accordance with SOPs and policy.

The role emphasizes confidentiality, time management, and effective communication across stakeholders. The ideal candidate holds a Philippines RN license, a Bachelor's in Nursing, and at least one year of clinical or medical

Qualifications

• Bachelor's degree in Nursing.
• Active Philippine RN license in good standing.
• Min. 1 year clinical experience or medical bill review.
• Proficient in word processing software.
• Strong analytical skills for bill review.
• Maintains professionalism and confidentiality.
• Able to multi-task, prioritize, and manage time.
• Excellent interpersonal and teamwork abilities.
• Completes continuing education requirements per PRC.
• Completes Crawford Educational Services courses.

Responsibilities

• Review medical information to determine medical necessity and appropriateness.
• Analyze information and apply criteria to assist utilization review.
• Collaborate with peer physicians for case resolution.
• Use resources to perform utilization review.
• Document pertinent information to support determinations and resolutions.
• Follow SOPs and turnaround times for reviews.
• Communicate policies to internal/external customers as needed.
• Plan and organize caseload to meet requirements.
• Communicate effectively with review process participants.
• Refer matters beyond authority to supervisor for direction.
• Protect confidentiality per Crawford Code of Conduct.
• Perform other related tasks as required.

Skills

Analytical skills

Word processing

Interpersonal skills

Attention to detail

Time management

Education

Bachelor's degree in Nursing

Job description

Crawford Educational Services in Manila, Philippines seeks a Nursing Utilization Review Specialist to review medical information for necessity and appropriateness. You will collaborate with physicians to resolve cases and document findings in accordance with SOPs and policy.

The role emphasizes confidentiality, time management, and effective communication across stakeholders. The ideal candidate holds a Philippines RN license, a Bachelor's in Nursing, and at least one year of clinical or medical