Utilization Review Nurse (US) – Makati

Genfinity; Makati; On-site; PHP 614,000 - 837,000; Full time

Job summary

Genfinity seeks a USRNs to join our Philippine site in Makati, providing utilization management services to promote quality medical care. You will gather medical data, evaluate treatment necessity, and collaborate with providers, employers, and adjusters to ensure prompt, cost-effective decisions.

The role requires an active nursing license in the Philippines and in the US, at least one year in UM, strong communication, and proficiency with MS Word and Excel. On-site work in Makati is required.

Qualifications

• Active nursing license in the Philippines and the mainland US.
• 1 year of experience in utilization management/review.
• Knowledge of ICD-10 codes and the criteria used in utilization reviews.
• Excellent verbal and written communication, organizational and leadership abilities.
• Proficiency in MS Word and Excel; comfortable with dual screens.
• Strong analytical, interpersonal and time-management skills.
• Willing to report on-site in Makati.

Responsibilities

• Facilitate communication with employees, providers, and adjusters.
• Gather medical data to evaluate necessity of treatment and functional abilities.
• Ensure timely processing of billings and utilization decisions.
• Resolve and make recommendations regarding medical care.
• Review referrals to determine appropriateness of treatment.
• Prepare reports reflecting activities and results for management.
• Participate in QM monitoring and department objectives.

Skills

Nursing license

Utilization Management

ICD-10 knowledge

Verbal & written communication

Time management

Leadership

Analytical skills

Interpersonal skills

Education

Nursing license (PH & US)

Tools

MS Word

Microsoft Excel

Job description

Genfinity seeks a USRNs to join our Philippine site in Makati, providing utilization management services to promote quality medical care. You will gather medical data, evaluate treatment necessity, and collaborate with providers, employers, and adjusters to ensure prompt, cost-effective decisions.

The role requires an active nursing license in the Philippines and in the US, at least one year in UM, strong communication, and proficiency with MS Word and Excel. On-site work in Makati is required.