Utilization Review Nurse

14 hours 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.

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