Utilization Review Nurse - InterQual & MCG Expert

Access Healthcare Services Manila, Inc.; Pasay; On-site; PHP 223,200 - 334,800; Full time

Job summary

A healthcare service provider in Pasay is seeking a highly skilled PH Registered Nurse (PHRN) to join their team. The ideal candidate must have an active PHRN license and at least 1 year of clinical experience. Responsibilities include conducting clinical reviews, analyzing patient records for medical necessity, and collaborating with medical directors. This is a full-time on-site position offering opportunities for quality improvement in patient care.

Qualifications

• Active PHRN license required.
• At least 1 year of clinical nursing experience in utilization review or case management preferred.
• Must have minimum acute bedside experience.

Responsibilities

• Conduct clinical reviews of inpatient and outpatient services.
• Analyze patient records for medical necessity.
• Collaborate with medical directors on complex cases.
• Ensure compliance with regulatory guidelines.
• Document and maintain review records.

Skills

Clinical nursing experience

Utilization review

Case management

InterQual guidelines

MCG guidelines

Education

Bachelor's degree in Nursing

Tools

InterQual

MCG

NCD

LCD

Job description

A healthcare service provider in Pasay is seeking a highly skilled PH Registered Nurse (PHRN) to join their team. The ideal candidate must have an active PHRN license and at least 1 year of clinical experience. Responsibilities include conducting clinical reviews, analyzing patient records for medical necessity, and collaborating with medical directors. This is a full-time on-site position offering opportunities for quality improvement in patient care.