US Registered Nurse (USRN), Quezon City

Job Title: US Registered Nurse (USRN)

License: Active US RN License (Compact or Single State)

Location: Philippines

Employment Type: Full-Time

Job Summary

The US Registered Nurse (USRN) provides clinical support and nursing expertise in alignment with US healthcare standards. The role involves clinical review, patient care coordination, utilization management, or telehealth services while ensuring compliance with regulatory, quality, and documentation requirements.

Key Responsibilities

• Perform clinical review, utilization management, or care coordination based on assigned function.
• Review and evaluate medical records for medical necessity, appropriateness of care, and compliance with US healthcare guidelines.
• Conduct telephonic or virtual patient assessments, education, and follow-ups when required.
• Collaborate with physicians, healthcare providers, case managers, and interdisciplinary teams.
• Ensure accurate and timely clinical documentation in electronic health record (EHR) systems.
• Apply evidence-based clinical guidelines, policies, and procedures.
• Maintain compliance with HIPAA, US healthcare regulations, and company policies.
• Support quality assurance, audits, and performance improvement initiatives.
• Escalate clinical concerns or complex cases following established protocols.

Qualifications

• Bachelor of Science in Nursing (BSN) or equivalent.
• Active and unrestricted US RN license (Compact or Single State).
• Minimum 13 years of clinical nursing experience (hospital, bedside, or relevant specialty preferred).
• Strong clinical assessment and critical thinking skills.
• Excellent written and verbal English communication skills.
• Proficiency in computer systems and electronic medical records.

Preferred Skills

• Experience in utilization review, case management, prior authorization, appeals, or telehealth.
• Familiarity with US healthcare systems, insurance processes, and payer guidelines.
• Experience working in a BPO or shared services healthcare environment.
• Ability to work night shifts or US business hours.