Deskripsi Pekerjaan
Join Med-Metrix International as a Utilization Review Nurse and become an integral part of our dynamic healthcare team. We offer exceptional benefits including 8-hour shifts, Day 1 HMO coverage for you and two dependents at no cost, comprehensive group life insurance, and competitive compensation. This full-time position allows you to leverage your clinical expertise to ensure optimal patient care while maintaining regulatory compliance and resource efficiency. As a Utilization Review Nurse, you'll play a pivotal role in evaluating medical necessity, coordinating care transitions, and improving patient outcomes through evidence-based decision-making. Our collaborative environment values professional growth, work-life balance, and continuous learning. If you're passionate about nursing excellence and seeking a role with tangible impact on healthcare quality, Med-Metrix International offers the perfect platform to advance your career while making meaningful contributions to patient care.
Tanggung Jawab
- Conduct thorough utilization reviews to determine medical necessity of patient admissions, extended stays, and discharge plans
- Collaborate with healthcare providers to facilitate appropriate care transitions and optimize resource utilization
- Analyze medical records and clinical documentation to ensure compliance with regulatory standards and organizational policies
- Develop and implement utilization management strategies that balance quality care with cost-effectiveness
- Communicate review findings and recommendations to stakeholders including physicians, case managers, and insurance providers
- Maintain accurate documentation of review processes and outcomes for audit and reporting purposes
- Stay current with evolving healthcare regulations, accreditation standards, and best practices in utilization management
Kualifikasi
- Bachelor of Science in Nursing (BSN) from an accredited institution
- Current and active Philippine nursing license with no derogatory records
- Minimum 2 years of clinical nursing experience, preferably in utilization review, case management, or quality assurance
- Strong analytical skills with ability to interpret complex medical information and clinical guidelines
- Excellent written and verbal communication skills for effective stakeholder collaboration
- Proficiency in electronic health records (EHR) systems and utilization review software
- Certification in Utilization Review (CURN) or Case Management (CCM) preferred