Utilization Review Nurse – Onsite Taguig, Growth & Impact

Cognizant; Taguig; On-site; PHP 600,000 - 900,000; Full time

Job summary

Cognizant in Taguig, Philippines is seeking a licensed healthcare professional to handle utilization management reviews for inpatient and outpatient services, medications, and treatment requests according to clinical guidelines. The role includes evaluating medical necessity, referring cases to physician reviewers when needed, and ensuring URAC, client policies, and turnaround-time requirements are met.

You will coordinate with physicians, healthcare providers, and stakeholders to deliver timely

Qualifications

• Active PHRN and USRN licenses are required.
• US Mainland license holder preferred.
• With Utilization Management experience.
• Excellent verbal and written communication skills.
• Comfortable handling voice-based healthcare processes.
• Willing to work onsite in Taguig.

Responsibilities

• Conduct utilization management reviews for inpatient and outpatient services, medications, and treatment requests based on clinical guidelines and client requirements.
• Evaluate medical necessity and refer cases requiring further review to physician reviewers.
• Ensure compliance with regulatory standards, URAC guidelines, client policies, and established turnaround times.
• Coordinate with physicians, healthcare providers, and stakeholders to facilitate timely review outcomes and determinations.
• Maintain accurate documentation and case records within utilization management systems.
• Communicate UM determinations and respond to member, provider, and stakeholder inquiries in a professional and timely manner.
• Support quality, compliance, and customer service objectives while safeguarding patient information and HIPAA requirements.
• Collaborate with healthcare and operations teams to improve processes, ensure service excellence, and drive positive patient outcomes.

Skills

Utilization Management

PHRN license

USRN license

Verbal communication

Written communication

HIPAA compliance

On-site work in Taguig

Voice-based processes

US license preferred

Job description

Cognizant in Taguig, Philippines is seeking a licensed healthcare professional to handle utilization management reviews for inpatient and outpatient services, medications, and treatment requests according to clinical guidelines. The role includes evaluating medical necessity, referring cases to physician reviewers when needed, and ensuring URAC, client policies, and turnaround-time requirements are met.

You will coordinate with physicians, healthcare providers, and stakeholders to deliver timely