PHRN - Utilization Review / Clinical Authorization
3 weeks ago
We're Hiring: PHRN Quality Auditor Clinical Services Location: Onsite, Mckinley, Taguig Schedule: Night Shift | Monday to Friday Hiring Target Date: Preferably by July 21, 2025 Salary Range: Up to 50k Qualifications Must hold an active PHRN license (Not a USRN holder) Prior experience as a Quality Auditor in a healthcare BPO clinical setting Alternatively, 4 to 7 years of specialized experience in Clinical Authorization or Utilization Review Strong knowledge of EPIC, MCG, or InterQual guidelines Must have a stable work history with minimal employment transitions Key Responsibilities I. Quality Auditing Conduct audits in accordance with Quality Improvement Plans (QIP)Provide actionable feedback to team members and track correctionsEscalate compliance concerns, trends, and anomalies to leadershipStay updated through production work and active participation in process updatesJoin client calls to ensure accurate capture of updates and compliance II. Clinical Process Management Verify patient insurance eligibility, benefits, and requirements with payersRequest, track, and secure pre-authorizations for medical services and proceduresReview and follow up on oncology chemotherapy drug authorizationsEnsure HIPAA compliance and maintain proper documentation in EHRHandle medical necessity documentation and assist in denial appealsPrioritize cases based on urgency and patient impactCommunicate with insurance companies, healthcare providers, and patients as neededAddress clinical inquiries based on payer medical policy guidelines
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Taguig, Philippines HRTX Full timeWe're Hiring: PHRN Quality Auditor Clinical Services Location: Onsite, Mckinley, TaguigSchedule: Night Shift | Monday to FridayHiring Target Date: Preferably by July 21, 2025 Salary Range: Up to 50k Qualifications Must hold an active PHRN license (Not a USRN holder)Prior experience as a Quality Auditor in a healthcare BPO clinical setting Alternatively, 4 to...
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PHRN – Clinical Authorization
2 weeks ago
Taguig, Philippines Go-Get Data Consultancy Full timeOverview Job title: PHRN – Clinical Authorization Work set up: Onsite Opportunity – MCK Taguig, Cyber Sigma Building Work schedule: Weekdays Night Shift schedule, Fixed Weekends Off Salary: 45K to 50K package if licensed PHRN, salary for approval if non-licensed Responsibilities Contact insurance carriers to verify patient’s insurance eligibility,...
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PHRN Quality Auditor
3 days ago
Taguig, Philippines Nezda Technologies, Inc. Full timePosition Title PHRN Quality Auditor - Prior/Clinical Authorization Location McKinley, Taguig Work Set-up Full Onsite | Night Shift Type Direct Hire | Permanent role Qualifications Must hold an active PHRN license With relevant experience as a Quality Auditor in Clinical Services within a healthcare BPO environment Open for Associate/CSR with 4+ years of...
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PHRN - Prior Authorization
2 weeks ago
Taguig, Philippines HRTX Full timeAbout the job PHRN - Prior Authorization Quality Auditor hiring Clinical Authorization Process.Onsite, Night Shift, Mon-Friday Qualifications Must hold an active PHRN license (not a USRN license holder) Relevant experience as a Quality Auditor in Clinical Services within a healthcare BPO environment; alternatively, 4 to 7 years of specialized experience in...
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PHRN - Prior Authorization Nurse
2 days ago
Taguig, National Capital Region, Philippines AUMTREND PH INC Full time ₱780,000 per yearPosition SummaryThe Prior Authorization Nurse (PHRN) will support the review and submission of prior authorization requests for behavioral health treatments, medications, or services. The nurse will review clinical documentation to ensure accuracy and medical necessity, complete required payer forms, and work closely with administrative support staff to...
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PHRN - Prior Authorization
3 weeks ago
Taguig, Philippines HRTX Full timeQuality Auditor hiring Clinical Authorization Process. Onsite, Night Shift, Mon-Friday Qualifications Must hold an active PHRN license (not a USRN license holder) Relevant experience as a Quality Auditor in Clinical Services within a healthcare BPO environment; alternatively, 4 to 7 years of specialized experience in Clinical Authorization or Utilization...
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PHRN - Prior Authorization
3 weeks ago
Taguig, Philippines HRTX Full timeQuality Auditor hiring Clinical Authorization Process. Onsite, Night Shift, Mon-Friday Qualifications Must hold an active PHRN license (not a USRN license holder)Relevant experience as a Quality Auditor in Clinical Services within a healthcare BPO environment; alternatively, 4 to 7 years of specialized experience in Clinical Authorization or Utilization...
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Prior Authorization Nurse
3 weeks ago
Taguig, Philippines HRTX Full timePosition: Clinical/Prior Authorization - Quality Auditor Qualifications: Must hold an active PHRN license (not a USRN license holder) Must have at least solid 4 to 7 years experience in Clinical/Prior Authorization or Utilization Review Relevant experience as a Quality Auditor in Clinical Services within a healthcare BPO environment (preferred only, not...
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Prior Authorization Nurse
3 weeks ago
Taguig, Philippines HRTX Full timePosition: Clinical/Prior Authorization - Quality Auditor Qualifications: Must hold an active PHRN license (not a USRN license holder)Must have at least solid 4 to 7 years experience in Clinical/Prior Authorization or Utilization ReviewRelevant experience as a Quality Auditor in Clinical Services within a healthcare BPO environment (preferred only, not...
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Prior Authorization Specialist
3 weeks ago
Taguig, Philippines HRTX Full timeWe are seeking a detail-oriented and organized Prior Authorization Specialist to join our healthcare team. In this role, you will be responsible for obtaining prior authorizations for medical procedures, diagnostic tests, and medications from insurance providers. You will serve as a key liaison between healthcare providers, patients, and insurance companies...
