Utilization Review Nurse

Job description

The Role International SOS is seeking an experienced Coordinating Benefit Review Nurse (CBRN) to support the US Department of Defense (DoD) Civilian Program. This role is responsible for reviewing the medical necessity and insurance coverage of healthcare services, facilitating access to appropriate care, and coordinating with healthcare providers, insurance carriers, and internal clinical teams to ensure quality healthcare outcomes. Key Responsibilities: Review healthcare service requests for appropriateness and benefit coverage. Coordinate referrals to appropriate healthcare providers and facilities. Assess medical cases and collect clinical information to support coverage decisions. Maintain accurate case documentation and uphold confidentiality standards. Collaborate with Japan-based clinical teams, providers, and stakeholders. Support quality assurance and adherence to clinical guidelines and regulatory standards. Qualifications: Active Philippine and US Registered Nurse (RN) licenses with at least 12 months validity. Bachelor's Degree in Nursing. Minimum of 5 years of clinical nursing experience. Experience in Medical Benefit Review within a BPO/shared services environment. Strong analytical, communication, customer service, and case management skills. Proficiency in MS Office and healthcare systems.