Utilization Review Nurse | USRN

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

Benefits offered by this job

Growth opportunities

Collaborative culture

Global impact

Job summary

Cognizant is seeking a Utilization Management professional in Taguig to conduct reviews for inpatient and outpatient services, medications, and treatment requests. The role requires evaluating medical necessity and coordinating with physicians to ensure timely determinations, while maintaining strict HIPAA compliance and client turnaround targets.

Onsite in Taguig, with opportunities for career growth. Candidates must hold active PHRN/USRN licenses, prefer US Mainland license, and have UM

Qualifications

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

Responsibilities

• Conduct UM reviews for inpatient and outpatient services, medications, and treatment requests.
• Evaluate medical necessity and refer cases to physician reviewers.
• Ensure compliance with URAC, client policies, and turnaround times.
• Coordinate with physicians and providers to facilitate timely determinations.
• Maintain accurate case documentation within utilization management systems.
• Communicate UM determinations to members, providers, and stakeholders.
• Support quality, compliance, and customer service while safeguarding patient information.
• Collaborate with care and operations teams to improve processes and outcomes.

Skills

Verbal and written communication

Voice-based healthcare processes

Job description

• Conduct utilization management (UM) 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.

Qualifications

• Active PHRN and USRN license
• 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

Preferred Background

• Medical Necessity Review
• Case Management
• Clinical Review

Why Join Us?

At Cognizant, we don’t just offer jobs—we build careers that thrive in the digital era.

• Growth That Matters – Clear career paths, continuous learning, and opportunities to move into leadership or specialized roles. You’re not just filling a seat—you’re building a future.
• Support That Empowers – A collaborative culture where your voice is heard, your ideas matter, and your well-being is prioritized through strong benefits and work-life balance.
• Impact That Inspires – Work on global accounts that shape industries, influence millions of users, and give you a sense of purpose beyond the paycheck.

Your future starts here—grow, thrive, and make an impact with Cognizant.