Utilization Review Nurse | UMR | PHRN | Pasay
7 days ago
Access Healthcare Services Manila, Inc. On-site - Pasay 1-3 Yrs Exp Bachelor Full-time Share Job Description We are seeking a highly skilled and detail-orientedPH Registered Nurse (PHRN) to join our team. The ideal candidate will have hands-on experience withInterQual ,MCG ,NCD , andLCD Guidelines Key Responsibilities Conduct clinical reviews of inpatient and outpatient services using InterQual, MCG, NCD, and LCD criteria. Analyze patient records to determine the medical necessity and appropriateness of services. Collaborate with medical directors and multidisciplinary teams to review complex cases. Ensure compliance with regulatory and payer-specific guidelines. Document and maintain accurate and comprehensive review records. Participate in quality improvement and audit initiatives. Qualifications Active PHRN license at least 1 year of clinical nursing experience in utilization review or case management experience preferred. Must have minimum acute bedside experience Proficient in usingInterQual andMCG guidelines . Strong working knowledge ofNCD and LCD criteria and application. Experience in developing or implementingclinical decision trees or algorithms. Working Location If the position requires you to work overseas, please be vigilant and beware of fraud. If you encounter an employer who has the following actions during your job search, please report it immediately withholds your ID, requires you to provide a guarantee or collects property, forces you to invest or raise funds, collects illicit benefits, or other illegal situations. Tips Some of our features may not work properly on your device. #J-18808-Ljbffr
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Pasay, Philippines Access Healthcare Full timeDirector Talent Acquisition at Access Healthcare Services We are seeking a highly skilled and detail-oriented PH Registered Nurse (PHRN) to join our team. The ideal candidate will have hands-on experience with InterQual , MCG , NCD , and LCD Guidelines Key Responsibilities Conduct clinical reviews of inpatient and outpatient services using InterQual, MCG,...
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Utilization Review Nurse
2 weeks ago
Pasay, National Capital Region, Philippines Private Advertiser Full time ₱900,000 - ₱1,200,000 per yearWe're looking for skilled Utilization Review Nurses (PHRN-USRN) to join our dynamic team and ensure medical necessity, cost-efficiency, and compliance with health plan policies and regulatory standards. QualificationsMust have active PHRN or USRN licenseMinimum of 2 years of acute care management in a hospital set upMust have 1 year of experience in...
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Utilization Review Nurse
1 week ago
Pasay, National Capital Region, Philippines Private Advertiser Full time ₱900,000 - ₱1,200,000 per yearWe're looking for skilled Utilization Review Nurses (PHRN-USRN) to join our dynamic team and ensure medical necessity, cost-efficiency, and compliance with health plan policies and regulatory standards. QualificationsMust have active PHRN or USRN licenseMinimum of 1 year of acute care management in a hospital set upMust have 1 year of experience in...
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Utilization Review Nurse
1 week ago
Pasay, National Capital Region, Philippines Access Healthcare Full time ₱360,000 - ₱540,000 per yearUtilization Review Nurse (PH Registered Nurse)Join our growing healthcare team and play a critical role in optimizing patient care, ensuring compliance, and supporting efficient healthcare delivery across client systems.Ideal CandidateMust be a Philippine Registered Nurse (PHRN) with an active license.Minimum 1-2 years of experience in Utilization Review...
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Utilization Review Nurse – Denials and Appeals
2 weeks ago
Pasay, National Capital Region, Philippines Access Healthcare Full time ₱420,000 - ₱540,000 per yearJob description:Access Healthcare is looking for REGISTERED NURSE to join our growing team.You'll be ensuring the completion of assigned patient cases by doing roll calls, processing concurrent and retro clinical reviews, work processing surgery authorizations, as needed.Responsibilities :Perform advanced level work related to clinical denial and utilization...
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Pasay, Philippines Access Healthcare Full timePHRN Clinical Trainer | UMR Experience Required We are seeking a motivated and experienced Clinical Trainer to join our Healthcare Business Processing Outsourcing Team. In this role, you will be responsible for overseeing the clinical training programs, ensuring deployed employees possess the necessary skills and knowledge to deliver exceptional services to...
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PHRN Clinical Trainer
10 hours ago
Pasay, National Capital Region, Philippines Access Healthcare Services Manila, Inc. Full time ₱60,000 - ₱120,000 per yearThe role Access Healthcare Services Manila, Inc.' is seeking a experienced PHRN Clinical Trainer to join our UMR team based in Pasay City Metro Manila. This is a full-time position and will play a crucial role in delivering high-quality training to our clinical staff.Key responsibilitiesDevelop and deliver comprehensive training programs to ensure clinical...
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Pasay, National Capital Region, Philippines Access Healthcare Full timeAccesshealthcare is looking for REGISTERED NURSE to join our growing team.You'll be ensuring the completion of assigned patient cases by doing roll calls, processing concurrent and retro clinical reviews, work processing surgery authorizations, as needed.QualificationsActive PHRN licenseat least 1 year of clinical nursing experience in utilization review or...
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PH Registered Nurse – Quality Analyst
2 weeks ago
Pasay, National Capital Region, Philippines access healthcare Full time ₱900,000 - ₱1,200,000 per yearWe are currently looking for Registered Nurse Quality Analyst to be part of our ClinicalteamThe Quality Analyst will be responsible for monitoring and evaluating the quality ofcustomer service interactions, identifying areas for improvement, and ensuringcompliance with policies and procedures. The successful candidate must be a RegisteredNurse with...
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Virtual Nurse Supervisor
4 weeks ago
Pasay, Philippines Infinit-O Full timeVirtual Nurse Supervisor (PHRN) Hybrid Setup | Nightshift Infinit-O Pasay, National Capital Region, Philippines Responsibilities Performance Management: Supervise, mentor, and coach a team of Virtual Triage Nurse Associates to meet and exceed performance metrics and quality standards. Training and Development: Oversee onboarding and ongoing professional...
