PHRN - Utilization Review / Clinical Authorization
1 week ago
We'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 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 corrections Escalate compliance concerns, trends, and anomalies to leadership Stay updated through production work and active participation in process updates Join client calls to ensure accurate capture of updates and compliance II. Clinical Process Management Verify patient insurance eligibility, benefits, and requirements with payers Request, track, and secure pre-authorizations for medical services and procedures Review and follow up on oncology chemotherapy drug authorizations Ensure HIPAA compliance and maintain proper documentation in EHR Handle medical necessity documentation and assist in denial appeals Prioritize cases based on urgency and patient impact Communicate with insurance companies, healthcare providers, and patients as needed Address 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, 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
6 days 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
1 week 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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PHRN - Prior Authorization
1 week 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
1 week 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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PHRN Quality Auditor
7 days ago
Taguig, National Capital Region, Philippines Nezda Technologies, Inc. Full timePosition Title: PHRN Quality Auditor - Prior/Clinical AuthorizationLocation: McKinley, TaguigWork Set-up: Full Onsite | Night ShiftDirect 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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Prior Authorization Specialist
1 week 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...
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Prior Authorization Specialist
1 week 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...
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Phrn
2 weeks ago
Taguig, National Capital Region, Philippines HRTX Full time ₱35,000 - ₱50,000 per yearWe'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 50kQualifications 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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Prior Authorization Nurse
2 weeks ago
Taguig, National Capital Region, Philippines HRTX Full time ₱600,000 - ₱1,200,000 per yearPosition: Clinical/Prior Authorization - Quality AuditorQualifications: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...
