Team Lead Clinical Reviewer (USRN)

• Review medical histories and develop evidence-based clinical recommendations consistent with established guidelines and formulary requirements.
• Prepare clear well-written clinical summaries documentation and discussion points to support outreach activities conducted by other team members.
• Maintain up-to-date knowledge of relevant clinical guidelines medication classes adverse effects and therapeutic alternatives.
• Oversee the workflow of clinical review activities ensuring adherence to regulatory client-specific and internal requirements.
• Assign monitor and track clinical review cases to ensure balanced workloads and timely completion of deliverables.
• Ensure accurate documentation and timely submission of all clinical determinations.
• Monitor team productivity quality and compliance metrics and address performance or process issues as needed.
• Serve as a subject matter expert on review processes requirements system workflows and clinical considerations.
• Identify opportunities for process improvements training enhancements and implementation of best practices.
• Provide mentorship coaching and feedback to support team development and performance.
• Participate in audits quality reviews and ongoing compliance monitoring activities.
• Adhere to all company policies procedures and applicable regulatory standards.
• Perform other related duties as assigned.

• Active and unrestricted Nursing License in the Philippines and mainland US (PHRN and USRN)
• Minimum of 2 years clinical nursing experience
• At least 1 year of clinical review utilization management case management or related US Healthcare experience
• Experience in PBM and or workers compensation is an advantage
• Prior experience in a leadership or senior reviewer role is preferred
• Strong knowledge of medication classes indications adverse effects therapeutic alternatives and
• clinical guideline
• Strong clinical judgment and analytical skills with ability to work independently
• Strong organization customer service and multitasking abilities
• Ability to exercise discretion and maintain confidentiality.
• Demonstrates initiative and problem-solving skills with minimal supervision.
• Ability to work collaboratively across teams and support organizational goals.
• Hybrid Set up willing to work on site in Makati and/or Pasig City during US business hours

All qualified applicants will receive consideration for employment without regard to race color religion gender gender identity sexual orientation national origin ethnicity age disability marital status or any other characteristic protected by law.

Genfinity as an Equal Opportunity Employer believes in each persons potential and well help you achieve yours.

All information will be kept confidential according to EEO guidelines.

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