Utilization Review Nurse - RN

Since 2008, 24HRPO has been a reliable provider of offshore HR services in the Philippines. We are committed to earning our clients' trust through unwavering transparency. By prioritizing open communication and close collaboration, we strive to understand and meet your unique needs. Our adaptable approach allows us to tailor our services—including sourcing, recruiting, payroll, and administration—to ensure the best outcomes for your organization. We believe in building long-term partnerships, not just being another vendor. Expect transparent communication, fair treatment, and a team dedicated to your success.

We are seeking a dedicated and experienced Utilization Review Nurse (RN) to join our team. The ideal candidate will possess clinical expertise and a strong understanding of healthcare regulations to ensure optimal patient care while managing resource utilization effectively. Location: 100% remote - but ust be residing and licensed in IL or TX Role: Utilization Review Nurse - RN

RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan. This position is responsible for performing accurate and timely medical review of claims suspended for medical necessity, contract interpretation, pricing; and to Initiate and/or respond to correspondence from providers or members concerning medical determinations.