Clinical Program Nurse II

KAVI Philippines is seeking a Clinical Nurse Auditor to perform comprehensive clinical audits for high-complexity claims. This role ensures medical necessity, regulatory compliance, and adherence to payer guidelines. You will apply your clinical judgment to evaluate services, admission status, level of care, and coverage determinations, while partnering with...

Responsible for auditing in-patient and/or surgical bills to promote excellence in medical bill review and process improvement.Medical Bill ReviewProcesses inpatient and/or surgical bills by adhering to the given standard operating procedures (SOP) and turnaround time to complete the task.Performs bill review process by utilizing appropriate...

DescriptionResponsible for auditing in-patient and/or surgical bills to promote excellence in medical bill review and process improvement.ResponsibilitiesMedical Bill ReviewProcesses inpatient and/or surgical bills by adhering to the given standard operating procedures (SOP) and turnaround time to complete the task.Performs bill review process by utilizing...

The Prior Authorization Clinical Specialist – US RN is responsible for providing clinical expertise and operational support in the prior authorization and utilization management process for U.S. healthcare payers. This role ensures medical necessity determinations are accurate, compliant, and timely by applying clinical judgment, payer policies, and...

KAVI Philippines seeks the Clinical Audit Supervisor. This role provides strategic and operational leadership to Clinical Nurse Auditors and Coding Denials Auditors while maintaining an active hands-on audit function. The Clinical Audit Supervisor ensures consistent application of medical review standards, audit methodology, and regulatory compliance across...

Job DescriptionPosted on5 January 2026A graduate of BS Nursing or any related medical course.Fresh graduates are welcome to apply.With at least a year of nursing experience.A sales-oriented and sales-driven individual.With excellent communication, analytical and managerial skills.With a positive, honest, and hardworking attitude.With good multi-tasking and...

The Medical City Iloilo is seeking a dedicated and highly skilledEmergency Room (ER) Staff Nursewho will play a crucial role in delivering prompt, safe, and high-quality nursing care to patients with urgent and life-threatening conditions. This role supports rapid assessment, immediate interventions, and coordinated emergency response in a dynamic,...

The Medical City Iloilo is looking for adedicated and highly skilled Recovery Room Staff Nursewho will play a vital role in providing safe, timely, and high-quality nursing care to patients immediately following surgical procedures. This role supports patient stabilization, monitoring, and post-anesthesia recovery in a fast-paced perioperative...

Now Hiring: Clinical Audit Supervisor (RN, BSN)Onsite | Night Shift | IloiloOur client is seeking an experiencedClinical Audit Supervisorto provide strategic and operational leadership to Clinical Nurse Auditors and Coding Denials Auditors, while remaining hands-on with complex clinical audits.This role supports accurate reimbursement, regulatory compliance,...

NURSING CLINICAL INSTRUCTORPerforms job functions consistent with the Institution's vision and mission statements and core values.Complies with institutional policies, procedures, and systems as contained in the administrative and operations manuals, memoranda, and related issuances.Participates in the course development and evaluation activities together...