PHRN - Utilization Review / Clinical Authorization

Position: 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...

We are looking for a knowledgeable and detail-driven PH Registered Nurse to join our growing clinical review team. This role is ideal for nurses who are experienced in applying clinical guidelines such as InterQual, MCG, NCD, and LCD, and who are comfortable evaluating the medical necessity of various healthcare services.What You'll DoUtilize InterQual, MCG,...

Quality Auditor hiring Clinical Authorization Process.Onsite, Night Shift, Mon-FridayQualificationsMust 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 Review...

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...

The opportunityAccess Healthcare Services Manila, Inc. is seeking a highly motivated and experienced PHRN | Utilization Review Nurse Team Leader to join our dynamic team. As the PHRN | Utilization Review Nurse Team Leader, you will play a crucial role in driving the success of our Utilization Review Nursing operations within the broader Healthcare & Medical...

Job description:We are hiring US Registered Nurses (USRN) with Utilization Management (UM) experience to join our growing healthcare operations team in BGC. If you are looking to move into a non-bedside, corporate healthcare role while still using your clinical expertise—this is for you.QualificationsActive  USRN licenseAt least 6 months...

Discover your 100% YOU with MicroSourcingPosition:Utilization Review Nurse SpecialistLocation:TaguigWork setup & shift:Onsite | Night shiftSign-on bonus: 50,000*Why join MicroSourcing?You'll have:Competitive Rewards: Enjoy above-market compensation, healthcare coverage on day one, plus one or more dependents, paid time-off with cash conversion, group life...

Discover your 100% YOU with MicroSourcingPosition:Clinical Review Nurse - Denials & AppealsLocation:TaguigWork setup & shift:Onsite | Night shiftWhy join MicroSourcing?You'll HaveCompetitive Rewards: Enjoy above-market compensation, healthcare coverage on day one (for you and at least one dependent), paid time-off with cash conversion, group life insurance,...

UST HealthProof is a trusted partner for health plans, delivering an integrated ecosystem designed to optimize health plan operations. Through our Business Process as a Service (BPaaS) solutions, we expertly manage complex administrative tasks, enabling our customers to focus on prioritizing the well-being of their members. Guided by our commitment to...

The Role: PHRN – Job DescriptionPosition: Philippine Registered Nurse (PHRN) Industry: Healthcare / BPO Work Type: Onsite / Hybrid / Remote (depends on account) Shift: Mostly Night Shift (US Healthcare Account)Job Summary:The PHRN will support US-based healthcare operations by reviewing clinical cases, processing claims, conducting utilization review, and...