Utilization Review Nurse

1 day ago

Pasig, National Capital Region, Philippines VISAYA Full time $40,000 - $60,000 per year

About 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 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 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.
  • Prior hospital experience, preferred
  • 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.

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 industry1.
  • 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.

  • Utilization Review Coordinator

    1 day ago

    Pasig, National Capital Region, Philippines Visaya Knowledge Process Outsourcing Corporation Full time $104,000 - $130,878 per year

    WE ARE HIRINGRole: Utilization Review CoordinatorOrtigas | Night Shift | Full-timeVisaya KPO is looking for a detail-oriented Utilization Review Coordinator/Medical Management Resolution Specialist to join our growing healthcare teamWhat you'll do:Review and resolve disputed medical claimsVerify and input case details for nurse reviewCollaborate with...

  • Healthcare Utilization Specialist

    4 days ago

    Pasig, National Capital Region, Philippines beBeeUtilization Full time ₱900,000 - ₱1,200,000

    Utilization Management Nurse RoleThis position is crucial in ensuring patients receive appropriate, timely, and cost-effective care by reviewing medical records, treatment plans, and healthcare resource utilization.

  • Healthcare Utilization Specialist

    4 days ago

    Pasig, National Capital Region, Philippines beBeeUtilization Full time ₱900,000 - ₱1,200,000

    Job DescriptionWe 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.The selected candidate will be responsible for conducting concurrent and retrospective...

  • Case Manager Nurse

    1 day ago

    Pasig, National Capital Region, Philippines TASQ Staffing Solutions Full time $104,000 - $130,878 per year

    Qualifications:Graduate of BS Nursing, USRN required.At least 1 year previous hospital nursing experience or Case Management experience in a clinical setting for a US-based healthcare company, required.Experience in Prior Authorization, Case Management and Utilization ReviewExperience:Prior Authorization: 1 year (Preferred)Case Management: 1 year...

  • Case Manager Nurse

    1 day ago

    Pasig, National Capital Region, Philippines TASQ Staffing Solutions Full time $104,000 - $130,878 per year

    TASQ is seeking a USRN case manager to join their team in Pasig on-site as soon as possible.The pre-screening interview will be done over the phone. Qualifications: - Bachelor's degree in nursing; a USRN license is mandatory. - A minimum of 1 year of hospital nursing or case management experience within a clinical setting for a US-based healthcare...

  • Prior-Authorization Nurses USRN

    1 day ago

    Pasig, National Capital Region, Philippines Visaya Knowledge Process Outsourcing Corporation Full time $40,000 - $60,000 per year

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

  • Company Nurse

    1 day ago

    Pasig, National Capital Region, Philippines Labrador Transparency (Asia) Full time $45,000 - $60,000 per year

    Job Title: Nurse – Benefits Administration AssistantWork Schedule: Night Shift– Monday to Friday, 9:00 PM to 6:00 AMWork Location:CBD Ortigas CenterDivision:AdministrationDepartment:Human ResourcesReports to:HRBP-PHPosition OverviewWe are seeking aRegistered Nursewith strong experience in employee health benefits administration to join our HR team. This...

  • USRN Nurse Trainer

    1 day ago

    Pasig, National Capital Region, Philippines TASQ Staffing Solutions Full time $104,000 - $130,878 per year

    About the job USRN Trainer (Pasig) | Onsite Work Setup/Shift: WFO / Night shift Start Date: ASAP Qualifications:Nursing Graduate (Bachelor's Degree)Active USRN License of any state (but NY is preferred)At least 1-2 years as a Process TrainerMinimum 1-2 years of US Healthcare account experience (Utilization Management Review and Clinical Appeals)Experience...

  • Company Nurse

    1 day ago

    Pasig, National Capital Region, Philippines Seven Seven Global Services, Inc. Full time $40,000 - $60,000 per year

    Company Nurse Responsibilities:• Develop and implement health and safety programs.• Provide emergency treatment in the workplace.• Administer over-the-counter medication to employees onsite.• Maintain a quality, clean and safe company's clinic• Document all employee injury and illness and keep this information confidential.• Improve the health of...

  • PH Registered Nurse

    1 day ago

    Pasig, National Capital Region, Philippines Omega Healthcare Management Services Inc. Full time $40,000 - $80,000 per year

    Duties & ResponsibilitiesWork post discharge, prebill accounts efficiently and effectively on a daily basis to resolve accounts with "no auth numbers, ALOS vs. authorized days or other discrepancies Evaluates clinical documentation on multiple patient accounts and escalates issues through the established channels Perform accurate and timely...