Utilization Review Nurse

Job Title:

Utilization Review Nurse (USRN Only - Dayshift)

Description:

About the Role
We are looking for a Medical Benefits Review Nurse who will review healthcare service requests and determine coverage eligibility based on clinical criteria and U.S. Federal Employee Health Benefit (FEHB) Program policies. This role supports Japan-based US DoD Civilians and involves close collaboration with regional medical teams.

Key Responsibilities

• Review and evaluate medical documentation based on established clinical guidelines and carrier policies.
• Ensure accuracy, efficiency, and quality in care management reviews.
• Coordinate with internal teams and Japan-based colleagues to obtain required case information.
• Maintain confidentiality and uphold ethical medical review standards.
• Support continuous improvement through data insights and collaboration.

Qualifications

• Active Philippines Registered Nurse license (valid for at least 12 months).
• Active USRN License. 
• Bachelor of Science in Nursing graduate.
• Minimum 2 years of clinical experience.
• Medical benefit review experience (URM) in a BPO supporting U.S. health insurance carriers (required).
• Strong communication, analytical, and customer service skills.
• Proficient in MS Office and able to navigate multiple systems.

Job Details:

• 12 hours duty. (4 days duty, 3 days off)
• Morning Shift
• Work Onsite in Ortigas, Pasig

Why join us?

• Be part of a global organization dedicated to providing exceptional medical and travel security services.
• Work in a dynamic and supportive environment.
• Opportunity to make a meaningful impact on the health and well-being of our clients.