Utilization Review Nurse
7 days ago
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 1 year 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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Utilization Review Nurse
1 week ago
Pasay, National Capital Region, Philippines Access Healthcare Full time ₱360,000 - ₱540,000 per yearUtilization 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 CandidateMust be a Philippine Registered Nurse (PHRN) with an active license.Minimum 1-2 years of experience in Utilization Review...
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Utilization Review Nurse
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Utilization Review Nurse
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Utilization Review Nurse – Denials and Appeals
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Pasay, National Capital Region, Philippines Access Healthcare Full timeAccesshealthcare 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.QualificationsActive PHRN licenseat least 1 year of clinical nursing experience in utilization review or...
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Pasay, National Capital Region, Philippines Access Healthcare Full timeWe 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...
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Pasay, National Capital Region, Philippines access healthcare Full time ₱900,000 - ₱1,200,000 per yearJob 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,...
