Clinical Utilization Specialist

4 weeks ago


Taguig, National Capital Region, Philippines Gratitude Philippines Full time
Job Title: Utilization Reviewer

Gratitude Philippines is seeking a highly skilled Utilization Reviewer to join our team.

Key Responsibilities:
  • Conduct thorough reviews of medical records to ensure compliance with workers' compensation laws and regulations.
  • Utilize strong analytical and organizational skills to identify areas for improvement in healthcare utilization.
  • Collaborate with healthcare providers to develop and implement effective case management plans.
  • Stay up-to-date with industry standards, including URAC standards, ODG, and workers' compensation guidelines.
  • Provide expert guidance on pain management and treatment options.
Requirements:
  • Bachelor's degree in nursing (BSN) and active unrestricted RN license.
  • 1-2 years of relevant clinical experience in medical/surgical departments, ICU, or emergency departments.
  • Excellent written and verbal communication skills in English.
  • Ability to work onsite in BGC and meet US operation hours.
Preferred Qualifications:
  • Proficiency in Microsoft Office products, including Project, Word, Excel, PowerPoint, Visio, and SharePoint.
  • Leadership and management skills, as well as strong organizational and analytical skills.

We offer a dynamic and supportive work environment, with opportunities for growth and development. If you are a motivated and detail-oriented professional with a passion for healthcare, we encourage you to apply.



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