Utilization Review Nurse (USRN) — Clinical Review & Compliance

Cognizant; Taguig; Presencial; PHP 600.000 - 900.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Growth opportunities

Collaborative culture

Global impact

Descripción de la vacante

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

Formación

• 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.

Responsabilidades

• 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.

Conocimientos

Verbal and written communication

Voice-based healthcare processes

Descripción del empleo

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