USRN UMR | 2+ Years UMR Experience | WFH After Training | Cebu Residents Only

• USRN UMR | 2+ Years UMR Experience | Inter
• Qual or MCG Required | WFH After Training | Cebu Residents Only
• Work Location: Cebu
• Work Setup: WFH after successful completion of onsite training
• Training: Mandatory onsite training in Cebu
• Shift: Night Shift
• Start Date: ASAPSalary Package: ₱65,000–₱90,000Industry: Healthcare BPOEmployment Type: Full-time

STRICT

REQUIREMENTS

• Must be currently residing in Cebu – STRICT REQUIREMENTActive USRN license
• Active PHRN license
• BS Nursing graduate2+ years of Utilization Management / Utilization Review (UMR/UR) experience
• Experience conducting Utilization Review

Inter

• Qual or MCG criteria experience – REQUIREDExperience with inpatient admission review and level-of-care determination
• Strong knowledge of clinical documentation and medical necessity review
• Strong clinical assessment and analytical skills
• Willing to undergo mandatory onsite training in Cebu
• Must be willing to transition to WFH after successful completion of training

ABOUT THE ROLEWe are looking for an experienced USRN UMR Specialist with strong Utilization Management/Utilization Review experience. The successful candidate will review medical records and clinical information to determine medical necessity, appropriate level of care, and authorization requirements using evidence-based criteria such as Inter

Qual or MCG.

KEY RESPONSIBILITIES

• Conduct utilization and medical necessity reviews
• Review inpatient admission requests and clinical documentation

Apply Inter

• Qual or MCG criteria to clinical cases
• Determine appropriate level of care, including inpatient versus observation
• Review medical records and supporting clinical information
• Identify missing or insufficient clinical documentation
• Evaluate clinical facts and evidence to support authorization decisions
• Communicate review findings and requirements to relevant stakeholders
• Maintain accurate and complete documentation of utilization reviews
• Follow established clinical, quality, and compliance standards
• REQUIRED EXPERIENCE2+ Years UMR/UR Experience
• Candidates should have hands-on experience in areas such as: Utilization Review

Utilization Management

Medical Necessity Review

Inpatient Admission Review

Level of Care Review

Inter

Qual or MCG Criteria

WORK SETUPMandatory Onsite Training in Cebu → WFH After Successful Training

Candidates must be willing to report onsite in Cebu during the required training period. After successfully completing training and meeting performance requirements, the position will transition to Work From Home.IMPORTANTCebu Residents Only

Applicants must currently reside in Cebu and be willing to complete the mandatory onsite training requirement.