PHRN Wanted! Utilization Management Nurse | Quezon City

About the role

The Utilization Management (UM) PHRN is responsible for the review, processing, and resolution of UM cases. The role ensures timely and clinically sound UM review, upholding member rights and health plan obligations under commercial and CMS regulations. The UM PHRN also supports case documentation and contributes to the quality and compliance targets of the payer program.

Key responsibilities

• Review, processing, and resolution of UM cases
• Ensure timely and clinically sound UM review
• Uphold member rights and health plan obligations under commercial and CMS regulations
• Support case documentation
• Contribute to the quality and compliance targets of the payer program

About you

• College Graduate (BSN)
• Active Nursing License
• At least six (6) months background in clinical process outsourcing and clinical role handling utilization management (BPO)
• At least 6 months bedside experience
• Willing to work onsite at Bridgetowne, Quezon City

Benefits

• HMO coverage, life insurance, leave conversion
• Fully Paid Training in communication, culture, and product expertise
• Education/Licensure Assistance Program with financial support for further studies and certifications
• Exclusive Partner Discounts
• High-Value Referral Bonuses
• Performance Incentives
• Night Shift Differential
• Mental Wellness Programs with professional support and wellness initiatives
• Clear, Accelerated Career Pathways with specialized courses, certifications, and language training