Utilization Review Nurse (USRN) - Morning Shift

International SOS (Phils.), Inc.; Pasig; On-site; PHP 420,000 - 700,000; Full time

Job summary

International SOS (Phils.), Inc. is seeking a Utilization Review Nurse to onsite in the Philippines. The role focuses on facilitating healthcare services, reviewing treatment requests for coverage, and ensuring ethical, confidential case management for U.S.

Government civilian employees. The incumbent will compile medical information, determine coverage based on policies, and coordinate referrals while collaborating with international teams.

Qualifications

• PH and US RN licenses (valid ≥ 12 months).
• BS Nursing degree obtained from accredited program.
• Minimum 5 years of clinical experience; benefit review/BPO experience is a plus.

Responsibilities

• Review medical treatment requests and assess coverage eligibility.
• Gather and evaluate clinical information to support case decisions.
• Coordinate referrals to appropriate facilities or specialists.
• Maintain accurate case documentation and uphold confidentiality.
• Collaborate with internal teams and international counterparts.

Skills

PH and US RN licenses

BS Nursing

Clinical experience

Education

BS Nursing

Job description

Job Title: Utilization Review Nurse (USRN)

Work Set-up: Onsite

Shift: Morning Shift | Fixed Weekends Off

Basic Function:

The Utilization Review Nurse is responsible for facilitating healthcare services, reviewing the appropriateness of requested treatments, and determining coverage based on health insurance policies for U.S. Government civilian employees. The role ensures high‑quality case management, proper medical referrals, and accurate documentation while upholding confidentiality and ethical standards.

Key Responsibilities

• Review medical treatment requests and assess coverage eligibility.

• Gather and evaluate clinical information to support case decisions.

• Coordinate referrals to appropriate facilities or specialists.

• Maintain accurate case documentation and uphold confidentiality.

• Collaborate with internal teams and international counterparts.

Qualifications

• PH and U.S. Registered Nurse licenses (valid ≥ 12 months).

• BS Nursing graduate.

• Minimum 5 years clinical experience; benefit review/BPO experience is a plus.