Utilization Reviewer Nurse

This role is an open-end contract position with a hybrid work setup. Please apply only if you are amenable to these terms.

The Utilization Reviewer evaluates the appropriateness and necessity of medical services provided to patients. Meticulously reviewing medical records ensures that care aligns with medical guidelines, insurance coverage, and patient needs. Collaborating closely with healthcare providers, you'll drive efficient resource utilization while maintaining high-quality patient care and cost-effectiveness.

Minimum Qualifications:

1. Must be a PH registered nurse.
2. At least 1 year experience in a clinical setting.
3. At least 1 year experience in a BPO setting.
4. Knowledge of HIPAA and US medical insurance is an advantage.
5. Fresh graduates with PHRN license may apply.