PHRN - Utilization Review / Clinical Authorization

2 days ago

Taguig, National Capital Region, Philippines HR TechX Corp. Full time
Overview

We are hiring for the PHRN - Utilization Review / Clinical Authorization role at HR TechX Corp. Location: Onsite, Mckinley, Taguig. Schedule: Night Shift | Monday to Friday. Hiring Target Date: Preferably by July 21, 2025. Salary Range: Up to 50k.

Qualifications
  • Active PHRN license (Not a USRN)
  • 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
  • Stable work history with minimal employment transitions
Key Responsibilities
  1. 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.
  2. 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.
Seniority level
  • Not Applicable
Employment type
  • Full-time
Job function
  • Health Care Provider
Industries
  • Technology, Information and Internet
#J-18808-Ljbffr

  • Clinical Authorization Specialist

    2 days ago

    Taguig, National Capital Region, Philippines beBeeClinicalAuthorization Full time ₱30,000 - ₱45,000

    About Our RoleWe are seeking a skilled professional to join our team in the field of Utilization Review and Clinical Authorization.Job OverviewThis role is responsible for conducting audits in accordance with Quality Improvement Plans (QIP), providing actionable feedback, and tracking corrections. Additionally, this position involves verifying patient...

  • Clinical Authorization Process Specialist

    2 days ago

    Taguig, National Capital Region, Philippines beBeeAuthorization Full time ₱1,200,000 - ₱2,000,000

    Healthcare Authorization SpecialistQuality Auditor hiring Clinical Authorization Process.Must hold an active PHRN license (not a USRN license holder)Relevant experience as a Quality Auditor in Clinical Services within a healthcare environment; alternatively, 4 to 7 years of specialized experience in Clinical Authorization or Utilization Review is...

  • Prior Authorization Nurse

    4 weeks ago

    Taguig, National Capital Region, Philippines HRTX Full time

    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 within a healthcare BPO environment (preferred only,...

  • Prior Authorization Specialist

    4 weeks ago

    Taguig, National Capital Region, Philippines HRTX Full time

    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 healthcare providers, patients, and insurance companies...

  • QA - Clinical Services

    2 weeks ago

    Taguig, National Capital Region, Philippines HRTX Full time

    What Were Looking For:Must have an active PHRN license2 to 5 years of hands-on experience in Clinical Authorization or Utilization Review (required)Prior experience as a Quality Auditor in Clinical Services within a healthcare BPO setting (a strong plus)Familiarity with EPIC, MCG, or InterQual (preferred, not required)Strong attention to detail and excellent...

  • Clinical Data Extractor

    11 hours ago

    Taguig, National Capital Region, Philippines beBeeData Full time $35,000 - $55,000

    Key ResponsibilitiesClinical Data Abstractors will be responsible for the effective abstraction and extraction of clinical data from various sources, ensuring accuracy and compliance with established guidelines.Abstract and extract relevant clinical data from patient records, medical charts, and other documents.Utilize knowledge of medical terminology and...

  • Clinic Operations Manager

    2 days ago

    Taguig, National Capital Region, Philippines Pettr App (formerly PetPal) Full time

    OverviewThe Clinic Operations Manager will oversee and manage all clinic secretaries and related partners across Pettr's clinic network. This role is responsible for ensuring secretary and partner performance, achieving key targets, and acting as the primary liaison between management, clinic owners, and secretarial staff. The Clinic Operations Manager will...

  • Medical Reviewer

    2 days ago

    Taguig, National Capital Region, Philippines eData Services US, L.L.C. Full time

    Medical Reviewer -- ATTN: Medical Fresh GradsResponsible for reviewing and analyzing documents pertaining to an individual, and composing accurate and complete reviews of records, either by paraphrasing or quoting the original documents, utilizing the Client guidelines.ResponsibilitiesCoordinates with the Production Supervisor and other Reviewers with regard...

  • Accurate Billing Specialist

    4 days ago

    Taguig, National Capital Region, Philippines beBeeChargeAudit Full time

    Medical Charge Auditor RoleThe company seeks a highly skilled Medical Charge Auditor to ensure accurate coding and compliance with industry standards.This is a fantastic opportunity for an individual who enjoys analyzing medical records, physician notes, and other documentation to identify billable services.Key Responsibilities:Analyze medical records,...

  • Medical Document Reviewer

    2 days ago

    Taguig, National Capital Region, Philippines beBeeMedical Full time ₱150,000 - ₱250,000

    We are seeking a detail-oriented professional to join our team as a Medical Document Reviewer. The ideal candidate will have a strong background in medical science and excellent analytical skills.In this role, you will be responsible for reviewing and analyzing documents pertaining to an individual, and composing accurate and complete reviews of records,...