Medical Utilization Reviewer – Night Shift (US)

About the role

We are seeking a Medical Utilization Reviewer to join our client’s healthcare operations team in Taguig. The role involves reviewing medical records and patient care documentation to ensure that services provided are appropriate, medically necessary, and aligned with clinical guidelines, supporting US‑based clients during night shifts.

Key responsibilities

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

Required profile

• Graduate or undergraduate degree in Medicine.
• Previous experience in utilization review, clinical documentation review, or healthcare quality (preferred).
• 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 abilities.
• Good written and verbal communication skills in English.
• Willingness to work onsite in Taguig and to cover night shifts for US‑based clients.

Required skills

• Medical terminology