Utilization Review Nurse

4 hours ago

Pasay, National Capital Region, Philippines Access Healthcare Full time ₱360,000 - ₱540,000 per year

Utilization Review Nurse (PH Registered Nurse)

Join our growing healthcare team and play a critical role in optimizing patient care, ensuring compliance, and supporting efficient healthcare delivery across client systems.

Ideal Candidate

  • Must be a Philippine Registered Nurse (PHRN) with an active license.
  • Minimum 1-2 years of experience in Utilization Review (UR), Case Management, or Clinical Review for healthcare clients.
  • Strong knowledge of hospital utilization review guidelines, medical necessity criteria, and clinical documentation standards.
  • Familiarity with EHR systems (e.g., Epic, Cerner) is a plus.
  • Excellent analytical, decision-making, and communication skills.
  • Ability to collaborate with physicians, nurses, and care teams to ensure proper utilization and documentation.

Job Responsibilities

  • Review inpatient and outpatient medical records to determine medical necessity, appropriateness of care, and length of stay.
  • Perform utilization review assessments in accordance with client, hospital, and regulatory standards.
  • Collaborate with healthcare teams, case managers, and physicians to resolve clinical discrepancies or documentation gaps.
  • Ensure accurate UR documentation to support insurance compliance, reimbursement, and quality standards.
  • Identify opportunities for process improvement and provide feedback to clinical teams.
  • Stay updated with utilization review guidelines, payer policies, and healthcare regulations.
  • Meet productivity and accuracy targets set by the company and client.

Job Type: Full-time

Pay: Php40, Php45,000.00 per month

Benefits:

  • Additional leave
  • Health insurance
  • Life insurance
  • Opportunities for promotion
  • Paid training
  • Pay raise
  • Promotion to permanent employee
  • Transportation service provided

Experience:

  • Utilization Review Nurse: 1 year (Required)

License/Certification:

  • PHRN (Required)

Work Location: In person

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