USRN Clinical Appeals Specialist, Supervisor Level

---ONLY THOSE APPLICANTS WHO ALREADY HAVE THE RIGHT TO LIVE AND WORK IN THIS COUNTRY ARE ELIGIBLE TO APPLY FOR THIS ROLE---

RESPONSIBILITIES:
Advance your USRN career with a Signing Bonus of up to ₱200,000.

Join our healthcare team and apply your clinical expertise in a rewarding non-bedside career. Available to qualified hires. Terms and conditions apply.

The USRN Utilization Management Nurse reviews clinical cases and medical documentation to support timely, evidence-based healthcare decisions. The role uses nursing expertise and Utilization Management experience to evaluate case information, prepare clinical summaries, identify documentation gaps, and communicate findings to clinical stakeholders.

This non-bedside opportunity allows experienced USRNs to deepen their expertise in Utilization Management, medical-necessity review, clinical documentation, and healthcare operations.

• Review medical records and clinical documentation for assigned UM cases.

• Evaluate case information based on established review processes and client guidelines.

• Prepare organized, concise, and accurate clinical summaries.

• Identify missing clinical information and coordinate follow-up as needed.

• Document review findings and case actions accurately.

• Support medical-necessity, care-management, and related clinical-review processes.

• Communicate relevant case information to clinical teams and medical directors.

• Manage assigned cases within required quality and turnaround-time standards.

• Protect confidential healthcare and patient information.

• Participate in quality reviews, process calibration, and continuous-improvement activities.

SKILL AND QUALIFICATIONS:
• Recognized nursing degree, diploma, or acceptable equivalent.

• Current and unrestricted US Registered Nurse license.

• At least three months or 480 hours of clinical RN experience involving direct patient care.

• Minimum of three (3) months of Utilization Management or Utilization Review experience.

• Strong written and verbal communication skills in English.

• Ability to analyze medical records and prepare clear clinical documentation.

• Working knowledge of standard computer applications.

Preferred Qualifications

• Clinical appeals, claims review, healthcare audit, insurance, or care-management experience.

• Quality assurance, Trainer, Team Lead, or subject-matter expert experience.

• Familiarity with ICD-9, ICD-10, or CPT codes.

• Experience in a healthcare BPO or clinical-process environment.

Work Arrangement

• Daily Onsite setup in Taguig

• Rotational or shifting schedule

#LI-PH

Taguig

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