Utilization Review Nurse - Hybrid (US Night Shift)

Med-Metrix; Pasig; Hybrid; PHP 446,400 - 669,600; Full time

Benefits offered by this job

8-Hour Shifts

Day 1 HMO coverage for dependents

Group Life Insurance

Medical Cash Allowance

Clothing Allowance

Paid Time Off

Free Lunch Daily

Training and Staff Development

Job summary

A healthcare management company is seeking a Utilization Review Nurse to evaluate the medical necessity of healthcare services. The role requires a valid PHRN license with experience in utilization management and clinical nursing. Responsibilities include conducting reviews and collaborating with healthcare providers to optimize member outcomes. This full-time position offers hybrid work arrangements and requires effective communication skills in English.

Qualifications

• Valid PHRN license; USRN license is a plus.
• 1-2 years experience in Utilization Management.
• Experience with UM criteria like MCG or InterQual.
• 2+ years clinical nursing experience in ambulatory or hospital setting.
• Proficient with Microsoft web-based applications.
• Experience in managed care and health insurance required.
• Effective communication in English, both written and verbal.

Responsibilities

• Conduct pre-certification and inpatient reviews as per UM policies.
• Determine medical necessity using initial clinical information.
• Collaborate with healthcare providers for optimal member outcomes.
• Review benefit determinations.
• Consult with UM Medical Director on medical necessity.
• Perform continued stay reviews and discharge planning.
• Generate written correspondence adhering to UM policies.

Skills

Clinical Nursing Experience

Utilization Management Criteria

Communication Skills

Computer Skills

Education

PHRN License

USRN License

Job description

A healthcare management company is seeking a Utilization Review Nurse to evaluate the medical necessity of healthcare services. The role requires a valid PHRN license with experience in utilization management and clinical nursing. Responsibilities include conducting reviews and collaborating with healthcare providers to optimize member outcomes. This full-time position offers hybrid work arrangements and requires effective communication skills in English.