PHRN - Utilization Review / Clinical Authorization
2 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 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 We are an equal opportunities employer and welcome applications from all qualified candidates. #J-18808-Ljbffr
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Taguig, Philippines HRTX Full timeAbout the job PHRN - Utilization Review / Clinical Authorization 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...
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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 – Clinical Authorization
4 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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Prior Authorization Nurse
2 weeks ago
Taguig, Philippines HR TechX Corp. Full timeOverview Join to apply for the Prior Authorization Nurse - PHRN (QA) role at HR TechX Corp. Position: 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...
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PHRN - Prior Authorization Nurse
3 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
4 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 ...
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Prior Authorization Nurse
2 weeks ago
Taguig, Philippines HRTX Full timeAbout the job Prior Authorization Nurse - PHRN (QA) Position: 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...
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PHRN - Prior Authorization
5 hours 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 Specialist
2 weeks ago
Taguig, Philippines HRTX Full timePrior Authorization Specialist (PHRN - Registered Nurse) Job openings: Prior Authorization Specialist (PHRN - Registered Nurse) About the job Prior Authorization Specialist (PHRN - Registered Nurse) We are seeking a detail-oriented and organized Prior Authorization Specialist to join our healthcare team. In this role, you will be responsible for obtaining...
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Prior Authorization Specialist
2 weeks ago
Taguig, Philippines HR TechX Corp. Full timePrior Authorization Specialist (PHRN - Registered Nurse) We 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...
