Utilization Review Nurse – Benefit Coordination

About the role

International SOS is looking for an experienced Utilization Review Nurse to support the U.S. Department of Defense Civilian Program. The role focuses on reviewing medical necessity and insurance coverage, ensuring patients receive appropriate care while maintaining compliance with clinical and regulatory standards.

Key responsibilities

• Review healthcare service requests for medical appropriateness and benefit coverage.
• Coordinate referrals to suitable providers and facilities.
• Collect and assess clinical information to support coverage decisions.
• Maintain accurate case documentation while upholding confidentiality.
• Collaborate with Japan‑based clinical teams, providers, and other stakeholders.
• Support quality‑assurance activities and adherence to clinical guidelines.

Required profile

• Active Philippine and U.S. 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 or shared‑services environment.
• Strong analytical, communication, customer‑service, and case‑management abilities.

Required skills

• Proficiency in Microsoft Office (MS Office).
• Familiarity with healthcare information systems.