Clinical Utilization Review Expert

2 days ago

Angeles City, Central Luzon, Philippines beBeeUtilization Full time ₱50,000 - ₱65,000
Job Opportunity

We are seeking an experienced Clinical Utilization Review Specialist to conduct reviews and analyses of healthcare services to ensure they meet quality and efficiency standards.

Key Responsibilities:
  • Conduct prospective, concurrent, and retrospective utilization reviews for inpatient and outpatient services according to URAC standards and client requirements.
  • Review and analyze healthcare services to identify areas for improvement and optimize resource allocation.
  • Communicate effectively with healthcare providers, payers, and other stakeholders to resolve discrepancies and enhance patient outcomes.
  • Develop strategic plans to reduce healthcare costs while maintaining high-quality patient care.
Requirements:
  • Active PHRN and USRN Mainland License.
  • At least 1 year of clinical bedside experience with a focus on Workers Compensation Utilization Management reviews and Healthcare Utilization Management Provider Appeals reviews.
  • Strong analytical and communication skills, with the ability to work independently and as part of a team.
Preferred Qualifications:
  • Background in team management and people management.

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