Utilization Reviewer

Job descriptionThe Reviewer is responsible for assessing the delivery of medical services to determine if the care provided is appropriate, medically necessary, and of high quality. This includes examination of documents to see if patients are given care consistent with their needs as well as inputting of approved Guidelines and References. The review...

The Reviewer is responsible for assessing the delivery of medical services to determine if the care provided is appropriate, medically necessary, and of high quality. This includes examination of documents to see if patients are given care consistent with their needs as well as inputting of approved Guidelines and References. The review typically involves...

OverviewWe are hiring for the PHRN - Utilization Review / Clinical Authorization role at HR TechX Corp. Location: Onsite, Mckinley, Taguig. Schedule: Night Shift | Monday to Friday. Hiring Target Date: Preferably by July 21, 2025. Salary Range: Up to 50k.QualificationsActive PHRN license (Not a USRN)Prior experience as a Quality Auditor in a healthcare BPO...

Medical Reviewer openings:* Medical Coder* Medical Editor* Medical Utilization Reviewer* Medical Virtual Assistant* Medical Virtual ScribeJob Description:Responsible for reviewing and analyzing documents pertaining to an individual, and composing accurate and complete reviews of records, either by paraphrasing or quoting the original documents, utilizing the...

Medical Reviewer -- ATTN: Medical Fresh GradsResponsible for reviewing and analyzing documents pertaining to an individual, and composing accurate and complete reviews of records, either by paraphrasing or quoting the original documents, utilizing the Client guidelines.ResponsibilitiesCoordinates with the Production Supervisor and other Reviewers with regard...

We are seeking a detail-oriented professional to join our team as a Medical Document Reviewer. The ideal candidate will have a strong background in medical science and excellent analytical skills.In this role, you will be responsible for reviewing and analyzing documents pertaining to an individual, and composing accurate and complete reviews of records,...

We are looking for a PHRN Team Lead to oversee and support a team of Utilization 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 the ability to guide and motivate a team in a fast-paced, remote work environment.Key...

Job Description:The role of Utilization Review Pharmacist involves conducting clinical reviews of medication requests to determine medical necessity, appropriateness, and compliance with plan guidelines. This position requires collaboration with medical directors, case managers, and providers to ensure safe, cost-effective, and evidence-based pharmaceutical...

Philippine Registered Nurse should have:Minimum of 1 year of direct bedside care experience in an acute care hospital setting (excluding clinics), with a strong preference for backgrounds in Emergency Room (ER), Intensive Care Unit (ICU), Medical-Surgical, Neonatal Intensive Care Unit (NICU), or Operating Room (OR) environmentsAt least 1 year of hands-on...

Job Summary:The Transport Supervisor is responsible for planning and organizing priorities related to transport activities and tasks; recognizes and obtains required equipment and/or materials that are needed to do the job; accomplishes tasks within established timelines; understands obstacles/ roadblocks; and makes alternative plans to ensure timely task...