Job Description

Job Title:

Utilization Review Nurse (USRN Only - Dayshift)

Description:


About the Role
We are looking for a Medical Benefits Review Nurse who will review healthcare service requests and determine coverage eligibility based on clinical criteria and U.S. Federal Employee Health Benefit (FEHB) Program policies. This role supports Japan-based US DoD Civilians and involves close collaboration with regional medical teams.


Key Responsibilities

  • Review and evaluate medical documentation based on established clinical guidelines and carrier policies.

  • Ensure accuracy, efficiency, and quality in care management reviews.

  • Coordinate with internal teams and Japan-based colleagues to obtain required case information.

  • Maintain confidentiality and uphold ethical medical review standards.

  • Support continuous improvement through data insights and colla...

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