Clinical Resource Specialist

3 days ago


Cebu City, Central Visayas, Philippines beBeeUtilization Full time ₱50,000 - ₱70,000

At Nezda, we are seeking a skilled and experienced Utilization Review Nurse to join our team.

Key Responsibilities:

  • Reviews service requests to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
  • Conducts medical management review activities which require the review of clinical information against client-specific criteria as noted above but excludes denial determinations.
  • Collaborates with clinical reviewers and/or U.S. licensed medical directors to ensure medically appropriate, high-quality, cost-effective care throughout the medical management process.

Qualifications:

  • Active USRN and PHRN License
  • At least 1 Year Clinical or Hospital Experience

Benefits:

  • Opportunity to work in a dynamic and growing company
  • Chance to make a meaningful impact on patients' lives

Location: Cebu



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