Minimum Requirements:

• Bachelor of Science Nursing (BSN) degree or General Nursing & Midwifery (GNM) Diploma or Basic Bachelor of Science (BSC) in Nursing degree or Associate Nursing Degree or Nursing Diploma

• Holds a current and unrestricted US Registered Nurse license is required

• 3 months clinical experience (480 hours of working experience as a RN)

• must have at least one year of Utilization Management experience.

• Work experience as an active RN license and providing direct patient care

• Clinical setting includes inpatient hospital, outpatient hospital or community clinic

• No state license required

• Should be able to start by December 2025

• Ready to work full onsite in Taguig

• Open for those applicants who are currently in Philippines and already have the right to live and work in this country  are eligible for this role

• Should not be a job hopper who only works for less than a year per company

Job Description

• Grievance & Appeals 

•  Creates complete appeal records for external appeal reviews, using standardized Independent Review Entity (IRE) forms and including all required documentation. 

• Creates a detailed case summary in narrative format for each appeal. 

• Submits cases as directed for each applicable geographic region. 

• Presents verbal and written case summaries to client’s Grievance Team and client Medical Directors. 

• Completes assignments within client-designated turnaround times.