PH RN (Utilization Management) - MOA, PASAY
Full-time
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Job Title: Philippine Registered Nurse (PHRN) – Utilization Management
About the Role:
We are currently supporting a global healthcare and analytics organization in hiring Philippine Registered Nurses (PHRN) to join their Healthcare Operations team. This role is ideal for nurses who want to transition into a healthcare operations environment while still applying their clinical knowledge to support patient care coordination and utilization management.
Key Responsibilities:
• Perform utilization review and assess medical records to determine medical necessity of healthcare services
• Review clinical documentation and ensure compliance with healthcare guidelines and policies
• Coordinate with healthcare providers, insurance companies, and internal teams regarding patient care services
• Evaluate treatment plans and medical procedures based on established clinical criteria
• Document case findings, recommendations, and decisions accurately in the system
• Support quality assurance and compliance with healthcare standards
• Ensure timely processing of cases while maintaining accuracy and confidentiality
Qualifications:
• Bachelor of Science in Nursing (BSN) graduate
• Active PRC Registered Nurse (RN) License
• At least one (1) year of clinical, hospital, or medical experience , or experience supporting US Healthcare accounts
• At least 1 year of Utilization Management experience
• Strong clinical assessment and documentation skills
• Good communication and analytical skills
• Willing to work on a night shift schedule
• Amenable to a hybrid work setup
Vacancy posted 3 days ago
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