Job Description

Make a Meaningful Impact with Your Clinical Expertise

Are you a passionate US Registered Nurse (USRN) looking to leverage your clinical knowledge beyond direct patient care while continuing to make a difference in people's lives

We are seeking a highly analytical and clinically driven Clinical Review Specialist to assess complex medical cases, provide evidence-based recommendations, and collaborate with healthcare professionals and business stakeholders. This is an excellent opportunity for nurses who thrive in challenging environments, enjoy critical thinking, and want to influence important healthcare and disability-related decisions.

In this role, your clinical expertise will directly support fair, balanced, and medically sound outcomes for employees, insured members, and healthcare partners.

Work Setup:100% Onsite | BGC, Taguig

Please note that this role requires employees to report onsite daily at our BGC, Taguig office. Candidates seeking remote or hybrid work arrangements may not be suitable for this position.

What You'll Do

As a Clinical Review Specialist, you will:

Review and evaluate medical records, claim files, and supporting documentation using evidence-based clinical standards and professional nursing judgment.
Analyze complex medical information and develop accurate, objective, and clinically supported assessments and recommendations.
Apply advanced critical thinking, clinical reasoning, and decision-making skills when reviewing cases with varying levels of complexity.
Lead and participate in high-impact discussions involving sensitive or challenging medical issues with internal and external stakeholders.
Confidently challenge information, recommendations, or decisions when clinical evidence indicates a different course of action.
Collaborate directly with Business/Leave Services teams, employees, insured members, attending physicians, and other healthcare professionals to gather, validate, and clarify medical information.
Serve as a trusted clinical resource by coaching and educating non-medical colleagues on relevant medical concepts and case considerations.
Maintain productivity and consistently meet quality, accuracy, and service-level expectations.
Demonstrate adaptability, urgency, and sound judgment in a fast-paced and evolving environment.
Stay current with industry trends, clinical best practices, and licensing requirements to maintain professional excellence.

What We're Looking For

Required Qualifications

Active and unrestricted US Registered Nurse (USRN) license
Minimum of 1 year of clinical nursing experience
Strong clinical assessment and medical record review skills
Proven ability to evaluate complex medical cases and arrive at balanced, evidence-based conclusions
Advanced critical thinking, analytical reasoning, and clinical decision-making capabilities
Excellent written and verbal English communication skills
Strong stakeholder management and interpersonal skills with the ability to navigate difficult conversations professionally and confidently
Must be willing and able to work onsite in BGC, Taguig on a full-time basis.
Candidates residing outside Metro Manila must be willing to relocate prior to start date.

Preferred Qualifications

Experience in Behavioral Health, Mental Health, or Psychiatric Nursing
Previous experience in utilization management, case management, disability management, clinical review, or insurance-related healthcare roles

Why Join Us

✅ Apply your nursing expertise in a highly specialized clinical review role

✅ Work with multidisciplinary stakeholders and healthcare professionals

✅ Expand your skills in medical analysis, decision-making, and case evaluation

✅ Influence meaningful outcomes through evidence-based clinical recommendations

✅ Thrive in a dynamic environment that values professional growth, collaboration, and continuous learning

If you're a clinically strong USRN who enjoys solving complex cases, influencing important healthcare decisions, and making an impact beyond bedside care, we'd love to hear from you. Apply today!