About This Role
Utilizing management nurses are crucial for ensuring quality healthcare support and positive patient outcomes. This role involves conducting utilization management reviews, evaluating medical necessity, and ensuring compliance with regulatory standards. It suits a USRN who is passionate about healthcare and continuous career development.
Responsibilities
- Conduct utilization management (UM) reviews for inpatient and outpatient services, medications, and treatment requests based on clinical guidelines and client requirements
- Evaluate medical necessity and refer cases requiring further review to physician reviewers
- Ensure compliance with regulatory standards, URAC guidelines, client policies, and established turnaround times
- Coordinate with physicians, healthcare providers, and stakeholders to facilitate timely review outcomes and determinations
- Maintain accurate documentation and case records within utilization management systems
- Communicate UM determinations and respond to member, provider, and stakeholder inquiries in a professional and timely manner
- Support quality, compliance, and customer service objectives while safeguarding patient information and HIPAA requirements
- Collaborate with healthcare and operations teams to improve processes, ensure service excellence, and drive positive patient outcomes
Requirements
- BS Nursing graduate
- Active PHRN and USRN license
- US Mainland license holder preferred
- Utilization Management experience
- Excellent verbal and written communication skills
- Comfortable handling voice-based healthcare processes
- Willing to work onsite in Taguig
Nice to have:
- Utilization Management (UM)
- Medical Necessity Review
- Case Management
- Clinical Review
Benefits
- Clear career paths, continuous learning, and opportunities to move into leadership or specialized roles
- Collaborative culture where your voice is heard, your ideas matter, and your well-being is prioritized through strong benefits and work-life balance
- Work on global accounts that shape industries, influence millions of users, and give you a sense of purpose
- Chance to win an iPhone 18 Pro Max through the FIRST WIN Promo for qualified hires
About the Company
Cognizant is a global organization that empowers healthcare professionals through innovation, collaboration, and continuous career development.
