USRN - Clinical Review Specialist
Sutherland · Taguig
Job description
About the role
The Clinical Review Specialist will evaluate medical records and claims, applying clinical expertise to make evidence‑based decisions. This onsite position in BGC, Taguig involves interacting with patients, providers, and internal teams to ensure accurate case handling.
Key responsibilities
- Review medical records and claims using clinical knowledge.
- Assess complex cases and provide clear, evidence‑based conclusions.
- Communicate with employees, patients/members, doctors, and internal teams to clarify medical information.
- Handle sensitive conversations professionally and provide guidance to non‑medical teams.
- Maintain accuracy, quality, and productivity in case handling.
- Stay updated on medical standards, practices, and industry developments.
Required profile
- Active US Registered Nurse (USRN) license.
- At least 1 year of experience in clinical claims or utilization review.
- Strong written and verbal English communication skills.
- Willingness to work onsite in BGC, Taguig.
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Published 1 hour ago
Expires 1 month from now
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Sutherland
Taguig