
Utilization Review Nurse
4 days ago
We are seeking a detail oriented and experienced Registered Nurse (RN) to join our PIONEER TEAM as a Virtual Utilization Review Nurse.
You'll be responsible for reviewing medical records and clinical documentation to determine the medical necessity, appropriateness, and efficiency of healthcare services provided. You'll work closely with physicians, case managers, and insurance providers to ensure optimal patient care while supporting cost containment efforts.
Key Responsibilities:- Conduct utilization reviews using evidence-based clinical criteria (e.g., MCG, InterQual).
- Evaluate the appropriateness of healthcare services and ensure alignment with payer policies and regulatory guidelines.
- Collaborate with healthcare providers and internal teams to gather clinical information.
- Prepare and document review findings, including approvals, denials, and referrals for peer review or further evaluation.
- Maintain up-to-date knowledge of industry guidelines, insurance regulations, and healthcare standards.
- Meet established productivity, quality, and turnaround time benchmarks.
- Support appeals processes as needed with clinical justifications.
- Active PRC License
- At least 1 year experience in acute hospital settings
- At least 1 year of experience in utilization review, case management, or medical management in BPO set up
- Strong knowledge of medical terminology and utilization management guidelines (InterQual, MCG).
- Strong knowledgeable in EPIC/CERNER
- Excellent communication and documentation skills.
- Proficient in electronic medical records (EMR) and UR platforms.
- Work onsite at Pasay
- Permanent night shift
-
Utilization Review Nurse
4 days ago
Pasay, National Capital Region, Philippines Private Advertiser Full time ₱900,000 - ₱1,200,000 per yearWe're looking for skilled Utilization Review Nurses (PHRN-USRN) to join our dynamic team and ensure medical necessity, cost-efficiency, and compliance with health plan policies and regulatory standards. QualificationsMust have active PHRN or USRN licenseMinimum of 1 year of acute care management in a hospital set upMust have 1 year of experience in...
-
PH Registered Nurse
1 week ago
Pasay, National Capital Region, Philippines access healthcare Full time ₱900,000 - ₱1,200,000 per yearPHRN – Team LeaderWe are looking for a Registered Nurse Team Lead to oversee and support a team ofUtilization Review Nurses in providing high-quality medical necessity reviews for our U.S.healthcare clients.This leadership role requires strong clinical knowledge, hands-on UR experience, and theability to guide and motivate a team in a fast-paced, remote...
-
Clinical Denials and Appeals Nurse
4 days ago
Pasay, National Capital Region, Philippines Access Healthcare Services Manila, Inc. Full time ₱900,000 - ₱1,200,000 per yearAccess Healthcare is looking for REGISTERED NURSE to join our growing team.You'll be ensuring the completion of assigned patient cases by doing roll calls, processing concurrent and retro clinical reviews, work processing surgery authorizations, as needed. Responsibilities :Perform advanced level work related to clinical denial and utilization...
-
Staff Nurse
4 days ago
Pasay, National Capital Region, Philippines RAINTREE HOME CARE SERVICES INC. Full time ₱300,000 - ₱360,000 per yearJob descriptionWe are hiring Staff Nurse for our senior's residence RainTree Care Services & Senior Residences in Pasay City.We are under German management and operate on German healthcare standards.RESONSIBILITIES AND DUTIES:Manage and Implement nursing care for our residentsManage chronic illnessConsult and collaborate with physicians, head nurse, and...
-
Staff Nurse
7 days ago
Pasay, National Capital Region, Philippines RAINTREE HOME CARE SERVICES INC. Full time ₱312,000 - ₱360,000 per yearJob descriptionWe are hiring Staff Nurse for our senior's residence RainTree Care Services & Senior Residences in Pasay City.We are under German management and operate on German healthcare standards.RESONSIBILITIES AND DUTIES:Manage and Implement nursing care for our residentsManage chronic illnessConsult and collaborate with physicians, head nurse, and...
-
Staff Nurse
4 days ago
Pasay, National Capital Region, Philippines RainTree Care Services & Senior Residences Full time ₱312,000 - ₱360,000 per yearJob descriptionWe are hiring Registered Nurse for our senior's residence RainTree Care Services & Senior Residences in Sucat Muntinlupa City and PasayWe are under German management and operate on German healthcare standards.RESONSIBILITIES AND DUTIES:Manage and Implement nursing care for our residentsManage chronic illnessConsult and collaborate with...
-
Head Nurse
4 days ago
Pasay, National Capital Region, Philippines RainTree Care Services & Senior Residences Full time ₱450,000 - ₱600,000 per yearPosition Goals* Providing professional and continuous nursing care with the following goals:* Promotes and restores resident's health by completing the nursing process.* Respecting the self-care abilities, self-determination, desires and habits of the residents, with appreciation and consideration of the abilities and wishes of relatives regarding the care.*...
-
House Parent/Utility
4 days ago
Pasay, National Capital Region, Philippines NEWINGTON BUILDERS Full time ₱695 per yearJob Description: Houseparent / Utility WorkerPosition Title: Houseparent / UtilityDepartment: Elderly Care / Home OperationsReports To: Home Administrator / Head of CarePosition SummaryThe Houseparent / Utility Worker provides day-to-day support to elderly residents by ensuring a clean, safe, and caring home environment. The role combines caregiving...
-
Registered Nurse
2 days ago
Pasay, National Capital Region, Philippines Infinit-O Full time ₱900,000 - ₱1,200,000 per yearInfinit-O isn't just about business process optimization, we're about people. For over 20 years, we've been helping some of the world's fastest-growing companies in Financial Services, Healthcare, and Technology achieve multiple strategic advantages through data-driven solutions, high-performance teams, and cutting-edge technology. Our world-class Net...
-
PH Registered Nurse – Quality Analyst
1 week ago
Pasay, National Capital Region, Philippines access healthcare Full time ₱900,000 - ₱1,200,000 per yearWe are currently looking for Registered Nurse Quality Analyst to be part of our ClinicalteamThe Quality Analyst will be responsible for monitoring and evaluating the quality ofcustomer service interactions, identifying areas for improvement, and ensuringcompliance with policies and procedures. The successful candidate must be a RegisteredNurse with...