Team Lead - Clinical Reviewer USRN

Founded in early 2019, Cadence Rx launched an industry-leading peer-to-peer prescription platform created to elevate our clients’ experience within the workers’ compensation market. These goals are achieved through agile responsiveness, advanced technology, and true transparency. Cadence Rx, Inc. is a privately held business based in Tampa, Florida. We are a nationally recognized woman-owned business exclusively serving the national workers’ compensation market. Cadence Rx is an agile and entrepreneurial enterprise led by a dedicated team of industry professionals who share extensive workers’ compensation knowledge, pharmacy expertise, and experience in offering a high touch customer service model.

Position Summary:
The Team Lead – Clinical Reviewer (US Registered Nurse) plays a key role in overseeing clinical review operations while providing direct clinical recommendations for injured workers. This position ensures that all clinical determinations align with established clinical guidelines, regulatory requirements, and Cadence Rx procedures. The Team Lead – Clinical Reviewer supports workflow management, maintains quality and timeliness standards, contributes to team development, and independently reviews medical histories to make evidence-based clinical recommendations. This role combines hands-on clinical review responsibilities with team leadership, process oversight, and subject matter expertise.

Roles and Responsibilities:

• 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 worker’s 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