PHRN Operations Manager for Appeals Denials

Job Title: PHRN Appeals DenialsShift: Night shiftWork Set-up: Onsite in Bridgetowne, Quezon CitySalary range: 50,762 package (Basic:43,762 and Allowance: 7K) with signing bonus to be released on their first payout for those who can join on Dec 9th/ImmediatelyTarget Start Date: December 9, 2025Headcount: 12Recruitment Process: VirtualQUALIFICATIONS:• An...

Medical Necessity Review for Appeals (Claims denied due to medical necessity)Job SummaryThe Operations Manager for Appeals is responsible for managing and overseeing operations related to clinical appeals. ensuring compliance with industry standards and regulatory requirements. The role involves close collaboration with various stakeholders to drive...

Qualifications:Active Philippine Registered Nurse (PHRN) with License Required1 Year(s) Minimum of Clinical Nursing Experience (Hospital, Clinic, or Managed Care Setting)6 Month(s) Minimum of Clinical Process Outsourcing Experience and Background Handling Clinical Role Focusing on Clinical Appeals and Utilization Management and Other Related FunctionStrong...

Compensation: NegotiableLocation: Onsite – Cebu CityWork Shift: ShiftingQualification:Bachelor's Degree in Nursing with an active and valid license in PHRNMust have at least 2 years experience in utilization management and medical necessity approvals and denialsClinical instructors with BPO/CPO experience are welcome to applyMinimum of 2 years of...

Salary range:50K - 65K, depending on the candidate's credentialsShift:Night shiftQUALIFICATIONS:• Bachelor's Degree in Nursing with an active and valid license in PHRN• Must have at least 2 years experience in utilization management and medical necessity approvals and denials• Clinical instructors with BPO/CPO experience are welcome to apply• Minimum...

CLINICAL LEADERSHIP HIRING2 PHRN Training & Quality ManagersSalary: 150,000 PHP + 10%Locations: 1 for Ortigas, 1 for QCQC – PHRN Healthcare Training & Quality ManagerSalary Range: 130,000 – 150,000 PHPRequirements:Minimum 2 solid years of PHRN Healthcare Training & Quality Manager experienceStrong background in UMR, Appeals, Denials, and InterqualSolid...

We are looking for a Training Quality Manager with strong experience in InterQual and Utilization Management Review (UMR) to lead training effectiveness, quality governance, and performance calibration for a healthcare BPO environment. This role is ideal for leaders who can drive measurable improvements and build high-performing clinical teams.Key...

Job Title: Operations Manager for Utilization Management - USRNShift: Night shiftWork Set-up: On-site in Bridgetowne, Quezon CitySalary range: 150K to 180KHC: 1Start date: Dec 31, 2025/ ASAPRecruitment Process: 2 interviews with Ops/virtual, Assessment depends on the recommendations after the interviewsLOB DESCRIPTION: Utilization Management - medical...

Job SummaryResponsible for overseeing training and quality initiatives for the Medical Necessity Review – Appeals program, ensuring compliance with client standards, regulatory requirements, and overall operational performance.Key ResponsibilitiesEnsure timely submission of all required deliverables (e.g., reports, trainee information updates, People...

Job SummaryResponsible for overseeing training and quality initiatives for the Medical Necessity Review – Appeals program, ensuring compliance with client standards, regulatory requirements, and overall operational performance.Key ResponsibilitiesEnsure timely submission of all required deliverables (e.g., reports, trainee information updates, People...