Utilization Management Nurse
Full-time
Global Recruitment and Consultancy OPC
Job description:
We are currently seeking a US Registered Nurse (USRN) with Utilization Management or Utilization Review experience to join a healthcare-focused operations team.
This position is ideal for nurses who want to transition further into a non-clinical, non-bedside career while continuing to utilize their nursing knowledge and clinical judgment. The role involves reviewing medical records, assessing clinical information, preparing case documentation, and supporting appropriate healthcare utilization decisions.
A signing bonus of up to ₱200,000 may be available to qualified candidates, subject to the applicable program requirements and conditions.
Key Responsibilities
- Review medical records and clinical documentation for assigned cases.
- Assess cases based on established clinical guidelines and review criteria.
- Prepare accurate clinical summaries and document review findings.
- Identify missing information and coordinate necessary follow-ups.
- Support medical-necessity, utilization, and care-management reviews.
- Communicate case findings with clinical teams and medical directors.
- Meet required quality and turnaround-time standards while maintaining patient confidentiality.
Qualifications
- Nursing degree, diploma, or equivalent.
- Active and unrestricted US RN license.
- At least 3 months/480 hours of direct patient-care RN experience.
- Minimum 3 months of Utilization Management or Utilization Review experience.
- Strong English communication and clinical documentation skills.
- Good analytical skills and computer proficiency.
Vacancy posted 1 day ago
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