Utilization Review Nurse

2 days ago

Ortigas, Philippines Visaya Knowledge Process Outsourcing Corporation Full time $60,000 - $100,000 per year
Job description

Role: Utilization Review/Management Nurse

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 1-2 years of solid experience in Utilization Review and Management.

  • 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.

#visayajobs

Job Type: Full-time

Benefits:

  • Company Christmas gift

  • Company events

  • Health insurance

  • Opportunities for promotion

  • Paid training

  • Promotion to permanent employee

Schedule:

  • 8 hour shift

Supplemental Pay:

  • 13th month salary

  • Overtime pay

Ability to commute/relocate:

  • Ortigas: Reliably commute or planning to relocate before starting work (Required)

License/Certification:

  • USRN license? (Required)

Work Location: In person

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