PHRN Utilization Reviewer

ISTA Solutions, an outsourcing/offshoring company, is in search of a Utilization Reviewer to join our rapidly expanding team. As a member of our team, you will have the opportunity to work with highly skilled professionals, who prioritize employee satisfaction and work-life balance. At ISTA Solutions, we pride ourselves on creating a culture focused on...

ISTA Solutions, an outsourcing/offshoring company, is in search of a Utilization Reviewer to join our rapidly expanding team. As a member of our team, you will have the opportunity to work with highly skilled professionals, who prioritize employee satisfaction and work-life balance. At ISTA Solutions, we pride ourselves on creating a culture focused on...

**What we offer: Salary Package: PHP 50,000 +**Sign-On Bonus: PHP 50,000Work Setup: Onsite at Bridgetowne, Quezon CitySchedule: Shifting ScheduleEssential Duties and ResponsibilitiesAccurately interpret member benefits and managed care products, and guide members to appropriate providers, programs, or community resources.Collaborate with medical directors...

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...

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...

Job Title: Operations Manager for Appeals - PHRNShift: Night shiftWork Set-up: On-site in Bridgetowne, Quezon CitySalary range: 120K to 150KStart date: Dec 31, 2025/ ASAPJOB DESCRIPTION: Medical necessity review for appeals (Claims denied due to medical necessity)JOB SUMMARY:The Operations Manager for Appeals is responsible for managing and overseeing...

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...

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...

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...