Utilization Review Nurse
Compensation
Not listed
Type
Full-time
Location
United States
Posted
Aug 10, 2026
Requirements Summary
Candidates must hold active Philippine and US Registered Nurse licenses and possess a Bachelor's Degree in Nursing. A minimum of 5 years of clinical nursing experience and prior experience in Medical Benefit Review within a BPO or shared services environment are required.
Core Responsibilities
The Utilization Review Nurse reviews healthcare service requests for medical necessity and insurance coverage while coordinating referrals and care. They also collaborate with clinical teams and stakeholders to ensure quality outcomes and adherence to regulatory standards.
Key Skills
Company Information
- Industry: Hospitals and Health Care
- Company Size: 10,001+ employees
- Type: Privately Held
- Specialties: international healthcare, medical assistance, security services, duty of care, travel, security, medical, risk, mobility, crisis, assistance, health, outsource, care, pandemic, evacuation, safety, expats, and concierge
Government Experience
- Federal Government Experience: Department of Defense
- Government Experience Preferred: Department of Defense
Full Job Description
The Role International SOS is seeking an experienced Coordinating Benefit Review Nurse (CBRN) to support the US Department of Defense (DoD) Civilian Program. This role is responsible for reviewing the medical necessity and insurance coverage of healthcare services, facilitating access to appropriate care, and coordinating with healthcare providers, insurance carriers, and internal clinical teams to ensure quality healthcare outcomes. Key Responsibilities: Review healthcare service requests for appropriateness and benefit coverage. Coordinate referrals to appropriate healthcare providers and facilities. Assess medical cases and collect clinical information to support coverage decisions. Maintain accurate case documentation and uphold confidentiality standards. Collaborate with Japan-based clinical teams, providers, and stakeholders. Support quality assurance and adherence to clinical guidelines and regulatory standards. Qualifications: Active Philippine and US 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/shared services environment. Strong analytical, communication, customer service, and case management skills. Proficiency in MS Office and healthcare systems.