Medical Utilization Reviewer

Job Expectations:

• Position Type: Associate - Individual Contributor
• Employment Type: Full-Time, Permanent (Direct Hire)
• Work Setup & Location: Fully Onsite - McKinley West Park, Taguig
• Work Schedule: Weekdays; Night Shift (US)
• Industry: Healthcare and Legal Outsourcing

About the Job:

We are looking for a Utilization Review Doctor to join our client's healthcare operations team and support the review of medical services and patient care documentation. In this role, you will evaluate medical records to determine whether treatments and services provided are appropriate, medically necessary, and aligned with established clinical guidelines. You will be responsible for reviewing, analyzing, and documenting case information while ensuring compliance with client-specific requirements and quality standards.

Key Responsibilities:

• Review medical records and healthcare documentation to assess the appropriateness and medical necessity of services provided.
• Analyze patient cases based on established clinical guidelines, references, and client-specific criteria.
• Perform medical record abstraction, review, and documentation activities.
• Evaluate treatment plans and healthcare services to ensure alignment with quality and utilization standards.
• Document findings, recommendations, and review outcomes accurately and comprehensively.
• Input and maintain approved clinical guidelines and reference materials as required.
• Collaborate with internal teams to ensure timely and accurate case reviews.
• Maintain confidentiality and compliance with healthcare regulations and documentation standards.
• Support continuous improvement initiatives related to utilization review processes and quality assurance.

Qualifications:

• Graduate or undergraduate in Medicine.
• Previous experience in utilization review, clinical documentation review, or healthcare quality is an advantage.
• Strong knowledge and understanding of medical terminology.
• Excellent active listening, typing, and auditory processing skills.
• Ability to document accurately while listening to live patient consultations.
• Strong attention to detail and organizational skills.
• Good written and verbal communication skills in English.
• Willing to work onsite in McKinley, Taguig.
• Willing to work night shifts supporting US-based clients.

-

RecruitNest is your trusted career partner, dedicated to connecting you with the right opportunities that match your skills, goals, and aspirations. We help you take the next step in your professional journey with personalized guidance and support.

Don't forget to follow us on LinkedIn to stay updated on upcoming and other job opportunities.