Medical Utilization Reviewer

About the role

We are seeking a qualified Medical Utilization Reviewer to join our client’s healthcare operations team in Taguig. In this full‑time, night‑shift position you will evaluate medical records and patient care documentation to ensure that treatments and services are appropriate, medically necessary, and aligned with clinical guidelines.

Key responsibilities

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

Required profile

• Graduate or undergraduate degree in Medicine.
• Willingness to work onsite in Taguig.
• Willingness to work night shifts supporting US‑based clients.
• Strong knowledge of medical terminology and attention to detail.

Required skills

• Excellent active listening, typing, and auditory processing abilities.
• Ability to document accurately while listening to live patient consultations.
• Good written and verbal communication skills in English.