Utilization Management Nurse

HealthEdge in the Philippines is hiring a clinical reviewer to evaluate medical necessity and determine appropriate level of care across inpatient, ambulatory, and ancillary services. You will review requests, prepare documentation, and support appeals for providers, facilities, and members.The role requires an active, unrestricted RN license with at least...

Utilization Review Nurse Location: Philippines About Us: HBiz is a leading Revenue Cycle Management (RCM) company dedicated to helping healthcare providers optimize their financial performance. We specialize in delivering innovative solutions that streamline revenue cycle operations and enhance overall revenue generation for healthcare organizations. Our...

A leading healthcare solutions provider seeks a dedicated Clinical Case Management Nurse to provide clinical guidance and support revenue cycle efficiency. Responsibilities include conducting clinical assessments, advocating for patients, and analyzing data for improvement. Ideal candidates have RN licensure, a BSN, and strong communication skills. This...

Level Up Talent Solutions is seeking a Lean-Pro US Registered Nurse with an active mainland U.S. RN license to support a non-voice healthcare operations account from a temporary WFH setup with onsite reporting as needed at Shearwater sites in Cebu, Manila, Pampanga or Davao.The role reviews healthcare information, applies clinical judgment, follows...

WFH AFTER REGULARIZATION! We are looking for Philippine Registered Nurses (PHRNs) to join our team as Utilization Review Nurses . If you have strong clinical knowledge, excellent attention to detail, and experience working with medical records and healthcare documentation, we’d love to hear from you! What You'll Do Review medical records, clinical...

The Manager, Utilization Review is responsible for overseeing the daily operations of the Utilization Review for one of our clients and leading a team of Utilization Review Nurses. This role involves ensuring efficient care coordination, managing healthcare costs, and maintaining high-quality patient care standards. The Manager, Utilization Review will...

Private Advertiser is seeking Philippine Registered Nurses (PHRNs) to join our team as Utilization Review Nurses. This role is WFH after regularization with initial training in Alabang, requiring strong clinical knowledge and attention to detail. You will review medical records, determine medical necessity, and ensure compliant documentation while meeting...

WORK SETUP:Full Remote — Day I onsite for equipment setLw; occasional onsite work as Backup internet required; laptop provided.ROLE OVERVIEWPerform prospective, concurrent, and retrospective reviews of care to ensure medical necessity, appropriate length of stay and level of care, including appeal requests from providers, facilities, and members.KEY...

HealthEdge in Taguig, Philippines, seeks a USRN for utilization management to perform prospective, concurrent, and retrospective reviews across inpatient to ambulatory services. You will assess medical necessity, coordinate care plans, and ensure appropriate levels of care while collaborating with providers and facilities.The role requires an active US RN...