W/ SIGN ON BONUS! Utilization Management Nurse | Quezon City

Concentrix Philippines; Quezon City; Presencial; PHP 391.000 - 614.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

HMO coverage

Life insurance

Paid training

Education/licensure assistance

Partner discounts

Referral bonuses

Performance incentives

Night shift differential

Mental wellness programs

Descripción de la vacante

Concentrix Philippines is seeking a Utilization Management (UM) PHRN to review, process, and resolve UM cases. The role ensures timely and clinically sound UM review while upholding member rights and health plan obligations under commercial and CMS regulations.

The successful candidate will support case documentation and contribute to the quality and compliance targets of the payer program, with on-site work at Bridgetowne, Quezon City.

Formación

• BSN degree required.
• Active nursing license required.
• At least six (6) months background in clinical process outsourcing and clinical role handling utilization management (BPO).
• At least 6 months bedside experience.

Responsabilidades

• Review, processing, and resolution of UM cases.
• Ensure timely and clinically sound UM review.
• Uphold member rights and health plan obligations under commercial and CMS regulations.
• Support case documentation.
• Contribute to the quality and compliance targets of the payer program.

Conocimientos

BSN

Active Nursing License

Clinical process outsourcing

Utilization management

Bedside experience

Educación

BSN degree

Descripción del empleo

About the role

The Utilization Management (UM) PHRN is responsible for the review, processing, and resolution of UM cases. The role ensures timely and clinically sound UM review, upholding member rights and health plan obligations under commercial and CMS regulations. The UM PHRN also supports case documentation and contributes to the quality and compliance targets of the payer program.

Key responsibilities

• Review, processing, and resolution of UM cases
• Ensure timely and clinically sound UM review
• Uphold member rights and health plan obligations under commercial and CMS regulations
• Support case documentation
• Contribute to the quality and compliance targets of the payer program

About you

• College Graduate (BSN)
• Active Nursing License
• At least six (6) months background in clinical process outsourcing and clinical role handling utilization management (BPO)
• At least 6 months bedside experience
• Willing to work onsite at Bridgetowne, Quezon City

Benefits

• HMO coverage, life insurance, leave conversion
• Fully Paid Training in communication, culture, and product expertise
• Education/Licensure Assistance Program with financial support for further studies and certifications
• Exclusive Partner Discounts
• High-Value Referral Bonuses
• Performance Incentives
• Night Shift Differential
• Mental Wellness Programs with professional support and wellness initiatives
• Clear, Accelerated Career Pathways with specialized courses, certifications, and language training