Medical Indexer, Abstract, Review jobs

Job Title: Utilization Review Specialist
Work Setup: 100% Work From Home

Compensation:

Up to ₱57,500 per month

• ₱42,500 Base Salary
• ₱15,000 Performance Bonus

Job Overview

We are seeking a detail-oriented and analytical Junior Utilization Review Specialist to join our team. This is a full-time, work-from-home position working directly with our California office and US-based team.

Work Schedule

• Monday to Friday
• 8:00 AM to 5:00 PM Pacific Standard Time
• Night shift (Philippine time equivalent)
• Must have a high-speed and reliable internet connection

Requirements:

• Reliable high-speed internet connection
• Quiet professional home office environment
• Ability to collaborate with U.S. clinical teams during business hours

Key Responsibilities

• Review clinical documentation from internal therapists and medical staff
• Prepare utilization review notes and clinical case summaries supporting medical necessity
• Assist with initial authorizations, concurrent reviews, and continued stay requests
• Communicate with internal therapists regarding missing or incomplete documentation
• Translate clinical documentation into structured UR summaries aligned with payer requirements
• Advocate for continued treatment authorization when clinically appropriate
• Track authorization periods and assist with timely submission of insurance reviews
• Identify documentation gaps that may impact insurance approval or reimbursement
• Maintain accurate records in the electronic medical record (EMR) system
• Ensure compliance with HIPAA and company documentation standards

Required Skills and Qualifications

• Strong analytical skills and exceptional attention to detail
• Excellent written and verbal English communication skills
• Strong typing speed and clinical documentation ability
• Ability to prepare clear, concise, and organized clinical summaries for insurance review
• Strong communication skills when coordinating with internal therapists and clinical staff
• Ability to manage workload independently in a remote work environment
• Proficiency in Microsoft Excel, Word, Outlook, and EMR systems

Required Experience

• Minimum 2 years experience working with U.S. health insurance (Required)
• Minimum 2 years experience working in a U.S. behavioral health treatment center (Required)
• Experience preparing utilization review documentation and clinical case summaries
• Experience supporting continued stay reviews and insurance authorization processes (Preferred)
• Experience working with U.S. healthcare organizations or clients (Preferred)

Clinical Knowledge Requirements

Candidates should have experience or familiarity with medical necessity criteria used in behavioral health utilization review, including:

• ASAM Criteria
• MCG Care Guidelines
• InterQual Criteria

Ability to review clinical documentation and align patient presentation with appropriate levels of care required for insurance authorization.

Education and Licensure

• Active Registered Nurse (RN) License (Required)

Preferred but not required:

• Active credential in healthcare, behavioral health, social services, or human services

Performance Expectations

• Ability to complete multiple utilization reviews per day while maintaining documentation accuracy
• Ability to quickly review clinical charts and prepare medical-necessity focused summaries
• Maintain strong communication with internal therapists to support continued stay authorization

Job Type: Full-time

Pay: Php42,500.00 per month

Benefits:

• Work from home

Experience:

• Work experience in working with US Health Insurance: 2 years (Required)

Language:

• English (Required)

License/Certification:

• Registered Nurse (RN) License (Required)

Work Location: Remote