Utilization Review Specialist (US Healthcare)

Position: Utilization Management Consultant 

Location: Manila, Philippines 

Overview: 

We are seeking a highly experienced Utilization Management Consultant to establish and optimize our Utilization Management (UM) process in Manila, Philippines. The consultant will design and implement comprehensive UM procedures, segregate roles and responsibilities, and build robust training programs for nurses and team managers. Additionally, the consultant will develop onboarding processes for new US clients. 

Key Responsibilities: 

1. Process Development: 

   - Design and implement a comprehensive Utilization Management process tailored to hospital and clinical review needs. 

   - Develop standardized protocols for utilization review, clinical reviews, and medical necessity appeals. 

2. Role Segregation: 

   - Clearly define and segregate roles and responsibilities within the UM team. 

   - Create detailed job descriptions for UM nurses, team managers, and other key roles. 

3. Training and Development: 

   - Develop and conduct training programs for UM nurses and team managers. 

   - Ensure training materials cover all aspects of UM, including clinical review procedures, compliance standards, and quality assurance. 

4. Client Onboarding: 

   - Design an efficient onboarding process for new US clients. 

   - Coordinate with the US-based team to ensure seamless integration of new clients into the UM system. 

5. Continuous Improvement: 

   - Establish metrics for evaluating the effectiveness of the UM process. 

   - Implement feedback loops and continuous improvement strategies to enhance process efficiency and quality. 

Qualifications: 

- Bachelor’s or Master’s degree in Nursing, Healthcare Administration, or a related field. 

- Minimum of 5 years of experience in Utilization Management, Utilization Review, and clinical review processes. 

- Proven experience in process development and team management. 

- Excellent communication and training skills. 

- Strong understanding of US healthcare regulations and compliance standards. 

Salary: 

- Competitive salary based on experience and qualifications. 

Application Process: 

Interested candidates should submit their resume and a cover letter detailing their relevant experience and approach to building a Utilization Management process. 

This position offers a unique opportunity to contribute to the establishment of a critical healthcare function in the Philippines, working with a dynamic and forward-thinking team.