Utilization Review Nurse

2 days ago

Pasay, National Capital Region, Philippines Private Advertiser Full time ₱900,000 - ₱1,200,000 per year

We'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.

Qualifications

  • Must have active PHRN or USRN license
  • Minimum of 2 years of acute care management in a hospital set up
  • Must have 1 year of experience in utilization review in a healthcare BPO set up
  • Strong knowledge of InterQual, MCG guidelines, CPT/ICD-10 coding, and medical terminology.
  • Excellent verbal and written communication skills.
  • Proficient in electronic medical records (EMR) and review systems.

Position Summary

As a Utilization Review Nurse, you will evaluate the appropriateness of medical services and procedures based on established clinical guidelines. You'll work collaboratively with physicians, healthcare professionals, and insurance providers to ensure optimal patient outcomes while maintaining cost-effective care.

  • Utilization Review Nurse

    1 week ago

    Pasay, National Capital Region, Philippines Access Healthcare Full time ₱400,000 - ₱450,000 per year

    e are seeking a detail oriented and experienced Registered Nurse (RN) to join our 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...

  • Utilization Review Nurse

    1 week ago

    Pasay, National Capital Region, Philippines Access Healthcare Services Manila, Inc. Full time ₱1,200,000 - ₱2,400,000 per year

    We are seeking a highly skilled and detail-oriented PH Registered Nurse (PHRN) to join our team. The ideal candidate will have hands-on experience with InterQual, MCG , NCD, and LCD GuidelinesKey ResponsibilitiesConduct clinical reviews of inpatient and outpatient services using InterQual, MCG, NCD, and LCD criteria.Analyze patient records to determine the...

  • Utilization Review Nurse

    4 days ago

    Pasay, National Capital Region, Philippines Access Healthcare Full time ₱800,000 - ₱1,200,000 per year

    We are seeking a highly skilled and detail-orientedPH Registered Nurse (PHRN)to join our team.The ideal candidate will have hands-on experience withInterQual,MCG,NCD, andLCDGuidelinesKey ResponsibilitiesConduct clinical reviews of inpatient and outpatient services using InterQual, MCG, NCD, and LCD criteria.Analyze patient records to determine the medical...

  • Utilization Review Nurse – Denials and Appeals

    2 days ago

    Pasay, National Capital Region, Philippines Access Healthcare Full time ₱420,000 - ₱540,000 per year

    Job description:Access 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...

  • Clinical Review Nurse – Denials

    2 days ago

    Pasay, National Capital Region, Philippines access healthcare Full time ₱900,000 - ₱1,200,000 per year

    Job description:Access 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...

  • Registered Nurse

    1 week ago

    Pasay, National Capital Region, Philippines Access Healthcare Full time ₱400,000 - ₱450,000 per year

    e 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...

  • PH Registred Nurse

    3 days ago

    Pasay, National Capital Region, Philippines Access Healthcare Full time ₱240,000 - ₱360,000 per year

    We are seeking a highly skilled and detail-oriented PH Registered Nurse (PHRN) to join our team.The ideal candidate will have hands-on experience with InterQual, MCG , NCD, and LCD GuidelinesKey ResponsibilitiesConduct clinical reviews of inpatient and outpatient services using InterQual, MCG, NCD, and LCD criteria.Analyze patient records to determine the...

  • PH Registered Nurse

    4 days ago

    Pasay, National Capital Region, Philippines access healthcare Full time ₱900,000 - ₱1,200,000 per year

    Job description:We are seeking a detail oriented and experienced Registered Nurse (RN) to join our 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,...

  • Nursing Scholar

    7 days ago

    Pasay, National Capital Region, Philippines Lean Solutions Group Inc. Full time ₱324,000 per year

    ECLARO: A quick SummaryECLARO is an award-winning professional services firm headquartered in New York City and operating in the U.S., Canada, UK, Ireland, Australia and the Philippines. We are dedicated to a singular purpose: providing the Right People to meet every client's needs and solve business challenges through strategic staffing, permanent...

  • Healthcare BPO for Registered Nurse

    2 weeks ago

    Pasay, National Capital Region, Philippines Access Healthcare Full time ₱40,000 - ₱45,000 per year

    Access 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...