Utilization Review Nurse, USRN

4 weeks ago

Pasig, Philippines VISAYA Full time

Overview

Visaya Pasig, National Capital Region, Philippines — 1 week ago Be among the first 25 applicants. Role Overview: We are seeking a skilled Utilization Management/Review Nurse to join our team. This role is essential in ensuring patients receive appropriate, timely, and cost-effective care by reviewing medical records, treatment plans, and healthcare resource utilization.

Role Overview (duplicate) — This role is to ensure appropriate, timely, and cost-effective care through utilization management activities.

Responsibilities
  • Conduct concurrent and retrospective reviews of patient clinical information to ensure medical necessity, appropriateness, and efficiency of services.
  • Review precertification and authorization requests for inpatient and outpatient care against established clinical guidelines and payer policies.
  • Collaborate with physicians, case managers, and healthcare professionals to coordinate care and discharge planning.
  • Analyze utilization trends and identify opportunities for improving resource use and cost-effectiveness while maintaining quality care.
  • Maintain accurate documentation of all utilization review activities and patient interactions.
  • Provide daily updates and reports to the Utilization Management Manager.
  • Educate healthcare staff and providers on utilization management policies and best practices.
  • Ensure compliance with regulatory requirements and internal policies related to utilization management.
  • Serve as a patient advocate to promote appropriate care and prevent unnecessary hospitalizations or procedures.
Qualifications
  • Graduate of BS Nursing with an active USRN license.
  • At least 2-4 years of solid experience in Utilization Review and Management.
  • Strong knowledge of clinical guidelines and medical necessity criteria is preferred (MCG/Interqual, etc.).
  • Excellent analytical, organizational, and communication skills.
  • Ability to work independently in a fast-paced environment.
  • Willingness to work onsite in Ortigas and on a night shift schedule.
  • Utilization Management or Case Management certification is a plus.
  • Experience with Prior Authorization: 2 years (Preferred); Hospital: 2 years (Preferred).
  • USRN license (Required).
Perks and Benefits
  • 15% Night Differential
  • HMO coverage after 30 days of employment (with option to add up to 2 dependents)
  • Retirement Benefits
  • 24 Leave Credits per year (convertible to cash)
  • Wholistic Employee Wellness Program
Why Join Visaya KPO?

Be part of a multi-awarded, 100% Filipino-owned company recognized for its leadership and innovation in the outsourcing industry. Work in a culture that values professional growth, employee well-being, and long-term partnerships. Enjoy industry-leading benefits and a supportive, inclusive environment. Visaya KPO is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

#J-18808-Ljbffr

  • Utilization Review Nurse

    4 weeks ago

    Pasig, Philippines VISAYA Full time

    Overview Visaya Knowledge Process Outsourcing Corporation is a proudly Filipino organization recognized globally for service excellence, innovation, and a culture of malasakit. We are committed to building long-term partnerships through quality, reliability, and a people-first approach. Role: Utilization Management / Review Nurse We are seeking a skilled...

  • Utilization Review Nurse, USRN

    4 weeks ago

    Pasig, Philippines Visaya KPO Full time

    Role Overview: We are seeking a skilled Utilization Management/Review Nurse to join our team. This role is essential in ensuring patients receive appropriate, timely, and cost-effective care by reviewing medical records, treatment plans, and healthcare resource utilization. Key Responsibilities: Conduct concurrent and retrospective reviews of patient...

  • Utilization Review Nurse, USRN

    3 weeks ago

    Pasig City, Philippines Visaya KPO Full time

    Role Overview: We are seeking a skilled Utilization Management/Review Nurse to join our team. This role is essential in ensuring patients receive appropriate, timely, and cost-effective care by reviewing medical records, treatment plans, and healthcare resource utilization. Key Responsibilities: Conduct concurrent and retrospective reviews of patient...

  • Prior-Authorization Nurses USRN

    4 weeks ago

    Pasig, Philippines Visaya KPO Full time

    WE'RE HIRING! – Prior-Authorization Nurse USRN – Pioneer Account Location: Ortigas (Onsite) Company: VISAYA Be part of a pioneer team supporting patient care through prior-authorization and utilization review services. Qualifications: Graduate of BS Nursing with an active USRN license At least 3–5 years of solid experience in: Utilization Review...

  • Utilization Review Nurse

    4 weeks ago

    Pasig, Philippines VISAYA Full time

    Overview Visaya Knowledge Process Outsourcing Corporation is a proudly Filipino organization recognized globally for service excellence, innovation, and a culture of malasakit. We are committed to building long-term partnerships through quality, reliability, and a people-first approach. Role Overview We are seeking a skilled Utilization Management/Review...

  • Prior-Authorization Nurses USRN

    3 weeks ago

    Pasig City, Philippines Visaya KPO Full time

    WE'RE HIRING! – Prior-Authorization Nurse USRN – Pioneer Account Location: Ortigas (Onsite) Company: VISAYA Be part of a pioneer team supporting patient care through prior-authorization and utilization review services. Qualifications: Graduate of BS Nursing with an active USRN license At least 3–5 years of solid experience in: Utilization Review...

  • USRN Lead/QA

    2 weeks ago

    Pasig, National Capital Region, Philippines VISAYA Full time ₱900,000 - ₱1,200,000 per year

    Role: USRN Team Lead/QA - Utilization ManagementAbout Visaya KPO:Visaya Knowledge Process Outsourcing Corporation is a proudly Filipino organization recognized globally for service excellence, innovation, and a culture of malasakit. We are committed to building long-term partnerships through quality, reliability, and a people-first approach.Role Overview:We...

  • usrn umr

    2 weeks ago

    Pasig, National Capital Region, Philippines Nezda Technologies, Inc. Full time ₱40,000 - ₱95,000 per year

    About the role Nezda Technologies, Inc. is seeking a talented registered nurse to join our team as a USRN UMR & PHRN - PRIOR AUTH. This is a full-time, based in Ortigas Pasig City Metro Manila. In this strategic position, you will play a crucial part in our efforts to deliver exceptional healthcare services to our clients.What you'll be doingReviewing and...

  • US Registered Nurse

    4 weeks ago

    Pasig, Philippines HRTX Full time

    Overview This position supervises a team of USRNs to deliver accurate, high-quality clinical support and services for healthcare clients within a BPO setting. The role includes managing team performance, providing training and coaching, and ensuring compliance with HIPAA, client policies, and SLA standards. Responsibilities Overseeing clinical processes such...

  • USRN Team Lead

    1 week ago

    Pasig, Philippines HR TechX Corp. Full time

    Key Responsibilities: Lead and manage a team of USRNs involved in clinical functions such as utilization management, case management, prior authorizations, appeals, or claims review. Track and evaluate team performance against established KPIs and SLAs, ensuring quality, productivity, and timely delivery. Ensure full compliance with HIPAA, client-specific...