Utilization Review Nurse - USRN Job at NTT DATA (Manila)

Clinical Reviewer Specialist

The Clinical Reviewer Specialist role involves conducting clinical reviews to pr...

Location

Philippines , Manila

Salary:

Not provided

NTT DATA

Expiration Date

Until further notice

Requirements

1-3 years of experience in processing appeals or utilization management
US Registered Nurse (USRN)
Knowledge of utilization management process
Knowledge of NCQA, Medicaid regulations
Good communication (Demonstrate strong reading comprehension and writing skills)
Able to work independently, strong analytic skills
Required shift timings - US daytime

Job Responsibility

Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards
Prepares case reviews for Medical Directors by researching the appeal, reviewing applicable criteria, and analyzing the basis for the appeal
Ensures timely review, processing, and response to appeal in accordance with State, Federal and NCQA standards
Communicates with providers, facilities and other departments regarding appeal requests
Generates appropriate appeals resolution communication and reporting for the member and provider in accordance with company policies, State, Federal and NCQA standards
Works with leadership to increase the consistency, efficiency, and appropriateness of responses of all appeal requests
Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry best practices
Uses sound judgement, especially in non-routine appeals, to make decisions to keep the appeal process moving forward in accordance with contractual timeliness standards
Maintain files on individual appeals by gathering, analyzing and reporting verbal and written member and provider appeals
Review claim appeal for reconsideration and recommend approvals/denials based on determination level or prepare for medical review presentation

Utilization Review Nurse Manager

The Utilization Review Nurse Manager will oversee a team responsible for managin...

Location

Philippines , Manila

Salary:

Not provided

NTT DATA

Expiration Date

Until further notice

Requirements

Typically requires 5- 9 years relevant experience
Should be open to work in night shifts
Undergraduate degree or equivalent combination of education and work experience
Solid communication skills
Demonstrated client service skills and leadership capabilities
Good knowledge, understanding and application of project management principles and methodologies
Models excellent analytical / problem solving skills
Good client service skills and leadership capabilities
Solid analytical / problem solving skills

Job Responsibility

Provides front-line supervision to an operational team of 35 or more employees
Supervised team typically responsible for manging US healthcare Payer claims adjudication process
Assigns work to direct reports
Recommends and takes actions hiring, firing, promotion, and disciplinary recommendations
Supervises team ensuring the highest quality of service is provided to clients
Monitors performance of the team and reports results and issues to higher-level leadership
Assists team with escalated client or account issues
Manages hiring, staffing and maintaining a diverse and effective workforce
Interacts with clients and internal departments to resolve issues
Works with the team to complete assignments using established guidelines, policies and procedures

Receptionist

We are looking for a detail-oriented Receptionist to join our team in Miami, Flo...

Location

United States , Miami

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Proficiency in using a multi-line phone system for managing calls
Strong customer service skills with the ability to handle inquiries professionally
Experience in data entry with attention to detail and accuracy
Ability to communicate effectively through email correspondence
Excellent interpersonal skills to interact with staff and visitors
Competence in Microsoft Excel, Outlook, and Word for administrative tasks
Organizational skills to manage files and maintain office order
Capability to schedule appointments and coordinate meetings efficiently

Job Responsibility

Oversee access to the office, ensuring security and proper protocols are followed
Manage the stocking and organization of supplies in the kitchens to maintain efficiency
Maintain the cleanliness and orderliness of the office environment to ensure a neat appearance
Handle incoming phone calls using a multi-line phone system, providing courteous and efficient service
Assist with scheduling appointments and coordinating meetings as needed
Perform accurate data entry tasks to support administrative functions
Organize and maintain files, ensuring easy accessibility and proper documentation
Communicate effectively via email to address inquiries and provide information
Execute various ad hoc projects and tasks as assigned to support office operations

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Psychiatrist

Astrya Global, a San Diego–based medical staffing agency, is hiring Psychiatrist...

Location

United States , San Bernardino

Salary:

Not provided

Astrya Global

Expiration Date

Until further notice

Requirements

Active CA licensure
Board certification
Active CA DEA
New graduates eligible

Job Responsibility

Evaluate and diagnose mental health disorders
Develop and implement treatment plans
See 15+ patients per day completing initial and follow up appointments
Prescribe and refill medications
Collaborate with up to 4 NPs as needed

What we offer

Malpractice Insurance
Weekly pay
Full-service credentialing and licensing department
Dedicated corporate travel team with airfare, car rental and hotel booking
Referral Bonus up to $5,000

Fulltime

Cook

Boston Pizza Cooks are the engine of the entire restaurant! They are responsible...

Location

Canada , Campbell River

Salary:

17.85 - 22.00 CAD / Hour

Boston Pizza

Expiration Date

Until further notice

Requirements

Collaborative
Team Player
Multi Tasker
Self-Starter
Detail Oriented
Efficient

Job Responsibility

Creating delicious menu items perfectly every time for every guest
Ensuring Guests have an excellent Boston Pizza experience from start to finish
Championing a fun and safe work environment
Contributing to a thriving workplace culture
Works alongside their team members
Builds relationships by finding common ground and working cohesively with all team members
Committed to championing the 'Heart of Hospitality', Boston Pizza's Brand Standards and Food Safety
Dedicated to providing Perfect Food Every Time to our Guests
Maintains composure and thrives in a fast pace environment
Works with a sense of purpose and always prioritize Guest’s orders

What we offer

Flex scheduling, days or nights
A discount on Canada's best gourmet pizza
A company entrenched in community service with opportunities to give back
Staff parties, pizza recipe contests etc
Work as part of an amazing team
BPI Scholarship Awards
Flexible scheduling that fits your lifestyle and contributes to your life-work balance
Exciting opportunities for career growth within the restaurant or at Boston Pizza head office
Build relationships and give back to your local community
Boston Pizza Scholarship Program

Specialist Education Support Assistant

Are you looking to get into supply or long‑term school-based support work? Are y...

Location

United Kingdom , South Gloucestershire

Salary:

Not provided

AFFINITY WORKFORCE

Expiration Date

Until further notice

Requirements

Hold an Enhanced Child DBS on the Update Service (or be willing to apply through AWS)
Have the ability to develop, encourage and promote learning
Have a passion for making a positive difference to children’s lives
Bring experience working within a UK school environment
Hold a valid safeguarding certificate
Demonstrate strong communication skills with children, staff and parents

Job Responsibility

Delivering targeted interventions
Supporting behaviour and pastoral needs
Helping pupils overcome barriers to learning
Providing lunchtime support

What we offer

Competitive daily rate
Opportunities to gain valuable, varied school experience
Access to exclusive rewards hub offering training, discounts & cashback
Generous referral bonus
Flexible work schedule
Temp-to-perm opportunities
Weekly pay

Psychiatrist

Astrya Global, a San Diego–based medical staffing agency, is looking for a psych...

Location

United States , San Diego

Salary:

250.00 - 260.00 USD / Hour

Astrya Global

Expiration Date

Until further notice

Requirements

M.D. or D.O. with active, unrestricted California medical license
Active California DEA
2 years of experience preferred
Credentialed with Optum and PAVE preferred

Job Responsibility

Conduct comprehensive psychiatric evaluations including DSM-5-TR diagnostic assessments and clinical formulation
Develop and oversee individualized treatment plans in collaboration with patients and multidisciplinary care teams
Prescribe, monitor, and adjust psychotropic medications while evaluating treatment response and side effects
Perform risk assessments for suicidality, homicidality, and danger to self or others, and implement appropriate safety planning
Coordinate care with psychologists, therapists, primary care providers, case managers, and community agencies to support integrated treatment
Provide crisis evaluation, stabilization, and psychiatric consultation as needed
Facilitate referrals to appropriate levels of care including inpatient, partial hospitalization (PHP), intensive outpatient (IOP), and residential treatment programs
Maintain accurate and timely clinical documentation in accordance with regulatory and organizational standards

What we offer

Malpractice Insurance
Weekly pay
Full-service credentialing and licensing department
Dedicated corporate travel team with airfare, car rental and hotel booking
Referral Bonus up to $5,000

Fulltime

Power Apps Developer

The Power Apps Developer is responsible for designing, developing, and maintaini...

Location

United States , Riviera Beach

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Bachelor’s degree in Information Technology, Computer Science, Business Systems, or related field OR equivalent combination of certifications and relevant experience in lieu of degree
Minimum 4–6 years of experience developing business applications or enterprise solutions
Minimum 2+ years of hands-on Power Platform development experience
Strong experience with: Power Apps (Canvas and/or Model-Driven)
Power Automate workflows
SharePoint and Microsoft 365 integration
Data modeling and structured data design
Ability to translate business requirements into technical solutions

Job Responsibility

Design, develop, and deploy custom business applications using Microsoft Power Apps (Canvas and Model-Driven apps)
Build solutions that support operational workflows, approvals, data collection, and reporting needs
Create responsive applications that function across desktop, tablet, and mobile platforms
Ensure applications follow enterprise architecture and security standards
Develop automated workflows using Power Automate
Integrate applications with enterprise platforms such as: SharePoint
Microsoft 365 services
Dataverse
SQL databases
Oracle or other enterprise systems (as applicable)

What we offer

medical
vision
dental
life and disability insurance
company 401(k) plan

Utilization Review Nurse - USRN

NTT DATA

Location:
Philippines , Manila

Category:
Nursing

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:
March 03, 2026

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