Job Summary
The USRN Utilization Review (UR) Nurse is responsible for evaluating the medical necessity and appropriateness of hospital admissions and continued stays by reviewing clinical documentation against established evidence-based guidelines. The role involves conducting first level reviews, inpatient admission reviews, and level-of-care utilization reviews using InterQualand MCG criteria to ensure patients receive appropriate care while supporting compliance with payer and regulatory requirements
Qualifications
- Must be a BS Nursing Graduate
- At least 1 yr and 6 months of related Utilization Review experience (First Level
Review, IP Admission Review, or Level of Care Utilization Review - Must have an active USRN license
- Utilize InterQual & MCG to determine hospital admission criteria
Work Arrangements
Work Location
- Cebu
Work Setup
- WFH
Start Date
- November 5
BENEFITS OFFERED:
- Competitive Total Rewards Package
- Target variable incentives
- Medical Plan (HMO) from Day 1 of employment with free dependents
- Life insurance
- Paid Time-Off Benefits
- Sick Leave Conversion
- Night Differential offered
- Employee Referral Program
- All Mandatory Statutory Benefit
ENDORSEMENT PROCESS:
- Endorse to R1 RCM Team
- R1 Team to validate the candidates and pre-screen the valid
- Workday profile creation for candidates
- Weekly Updates
ENDORSEMENT PROCESS:
- Endorsement to WD
- Assessment
- HM Interview
- Passed HM Interview
- Inform candidates of status (R1 to request recent pay slip – 1 month)
- Job Offer
Job Category: Healthcare
Job Type: Full Time