Utilization Review Nurse

1 day 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-oriented
PH Registered Nurse (PHRN)
to join our team.

The ideal candidate will have hands-on experience with
InterQual
,
MCG
,
NCD
, and
LCD
Guidelines

Key Responsibilities

  • Conduct clinical reviews of inpatient and outpatient services using InterQual, MCG, NCD, and LCD criteria.
  • Analyze patient records to determine the medical necessity and appropriateness of services.
  • Collaborate with medical directors and multidisciplinary teams to review complex cases.
  • Ensure compliance with regulatory and payer-specific guidelines.
  • Document and maintain accurate and comprehensive review records.
  • Participate in quality improvement and audit initiatives.

Qualifications

  • Active PHRN license
  • at least 1 year of clinical nursing experience in utilization review or case management experience preferred.
  • Must have minimum acute bedside experience
  • Proficient in using
    InterQual
    and
    MCG guidelines
    .
  • Strong working knowledge of
    NCD and LCD
    criteria and application.
  • Experience in developing or implementing
    clinical decision trees
    or algorithms.

  • Utilization Review Nurse

    7 days 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

    7 days 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...

  • Registered Nurse

    7 days 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

    1 day 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

    1 day 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,...

  • Denials and Appeals Nurse

    5 days ago

    Pasay, National Capital Region, Philippines Access Healthcare Services Manila, Inc. Full time ₱900,000 - ₱1,200,000 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...

  • Denials and Appeals Nurse

    5 days ago

    Pasay, National Capital Region, Philippines Access Healthcare Full time ₱540,000 - ₱660,000 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...

  • Nursing Scholar

    5 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...

  • PH Registered Nurse Clinical Denial and Appeals

    5 days ago

    Pasay, National Capital Region, Philippines Access Healthcare Full time ₱450,000 - ₱550,000 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...

  • Healthcare BPO for Registered Nurse

    1 week 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...