Utilization Review jobs in Pasay

Role Description UST HealthProof is a trusted partner for health plans, delivering an integrated ecosystem designed to optimize health plan operations. Through our Business Process as a Service (BPaaS) solutions, we expertly manage complex administrative tasks, enabling our customers to focus on pri

NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now. We are currently seeking a Utilization Review Nurse Manager (USRN) to join our team in Manila, Nation

We are looking for a knowledgeable and detail-driven PH Registered Nurse to join our growing clinical review team. This role is ideal for nurses who are experienced in applying clinical guidelines such as InterQual , MCG , NCD , and LCD , and who are comfortable evaluating the medical necessity of v

Discover your 100% YOU with MicroSourcing! Position: Clinical Denials & Appeals Nurse Specialist – IP & OP Location: BGC, Taguig City Work setup & shift: Onsite | Night shift Sign-on bonus: 50,000* Why join MicroSourcing? You'll have Competitive Rewards: Enjoy above-market compensation,

Role: Utilization Review/Management Nurse, USRN About Visaya KPO: Visaya Knowledge Process Outsourcing Corporation is a proudly Filipino organization recognized globally for service excellence, innovation, and a culture of malasakit. We are committed to building long-term partnerships through qualit

Discover your 100% YOU with MicroSourcing! Position: Utilization Review Nurse Specialist Location: Taguig Work setup & shift: Onsite | Night shift Sign-on bonus: 50,000* Why join MicroSourcing? You'll Have Competitive Rewards: Enjoy above-market compensation, healthcare coverage on day one, plus

A Utilization Review (UR) Nurse is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services, ensuring patients receive the right care while controlling costs. They act as a bridge between hospitals, insurance companies, and patients, reviewing treatmen

Position Summary The Utilization Review Nurse is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services across inpatient and outpatient settings. This role ensures that care aligns with clinical guidelines, payer requirements, and organizational poli

NTT America, Inc.

NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now. We are currently seeking a Utilization Review Nurse Manager (USRN) to join our team in Manila, Nation

Agile Tech Ops Inc.

₱50,000 - ₱60,000 /year

## Clinical Reviewer (Utilization Review Nurse - USRN) Job Type: Full-Time (Hybrid: 3x onsite / 2x WFH) Location: Ayala, Makati Schedule: Morning Shift ## About the Role We are looking for a detail-oriented Clinical Reviewer (USRN) to support a U.S.-based healthcare organization. This role is respon

Quality Auditor Clinical Reviewer (Utilization Review Nurse - USRN) Job Type: Full-Time (Hybrid: 3x onsite / 2x WFH) Location: Ayala, Makati Schedule: Morning Shift About the Role We are looking for a detail-oriented Quality Auditor Clinical Reviewer (USRN) to support a U.S.-based healthcare organiz

Access Healthcare Services Manila, Inc.

A healthcare service provider in Pasay is seeking a highly skilled PH Registered Nurse (PHRN) to join their team. The ideal candidate must have an active PHRN license and at least 1 year of clinical experience. Responsibilities include conducting clinical reviews, analyzing patient records for medic

*Roles and Responsibilities** Provides front-line supervision to an operational team of 35 or more employees Supervised team typically responsible for managing US healthcare Payer claims adjudication process Assigns work to direct reports. Recommends and takes actions hiring, firing, promotion, and

International SOS (Phils.), Inc.

*Job Title:** Utilization Review Nurse (USRN) *Work Set-up:** Onsite *Shift:** Morning Shift *Basic Function:** The Utilization Review Nurse is responsible for facilitating healthcare services, reviewing the appropriateness of requested treatments, and determining coverage based on health insurance

MicroSourcing

A leading managed services provider is looking for a Utilization Review Nurse Specialist in Taguig. This role involves optimizing patient care by ensuring healthcare services are necessary and efficient. Candidates should have at least 1 year of utilization review experience and a BS in Nursing. The

MicroSourcing

A leading offshore service provider in Metro Manila seeks a Clinical Review Nurse to optimize clinical outcomes and manage healthcare service utilization. Responsibilities include conducting reviews of medical records for necessity, collaborating with physicians for documentation, and ensuring compl

A global technology services leader is seeking a Utilization Review Nurse to manage clinical reviews for appeals remotely from Manila. This role involves analyzing medical records, ensuring compliance with NCQA standards, and communicating effectively with healthcare providers. The ideal candidate w

NTT DATA North America

A global technology services leader is seeking a Utilization Review Nurse to manage clinical reviews for appeals remotely from Manila. This role involves analyzing medical records, ensuring compliance with NCQA standards, and communicating effectively with healthcare providers. The ideal candidate w

A global technology services leader is seeking a Utilization Review Nurse to manage clinical reviews for appeals remotely from Manila. This role involves analyzing medical records, ensuring compliance with NCQA standards, and communicating effectively with healthcare providers. The ideal candidate w