PHRN – Clinical Authorization
2 weeks ago
Overview 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, benefits and requirements. Request, track and obtain pre-authorization from insurance carriers within time allotted for medical and services. Review, request, follow up and secure authorizations for high dollar cost oncology chemotherapy drugs. Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations. Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed. Review denials and follow up with provider to obtain medically necessary information to submit an appeal of the denial. Prioritize the incoming authorizations by level of urgency to the patient. Manage correspondence with insurance companies, physicians, specialists, and patients as needed, including documenting in the EHR as appropriate. Respond to clinical questions regarding payer medical policy guidelines Qualifications Active PHRN license preferred but not required, as long as the candidate is a BS Nursing graduate Must not hold a USRN license At least 6 months of experience in Clinical or Prior Authorization, with familiarity in medical necessity guidelines or criteria At least 6 months of bedside nursing experience preferred but not required Knowledge in EPIC or any Electronic Health Record preferred Must be amenable to start immediately, onboarding will start on Wednesday, April 30 #J-18808-Ljbffr
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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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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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Taguig, Philippines HRTX Full timeWe'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...
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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 ReviewRelevant 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 Review Relevant 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...
