PHRN - Denials & Appeals Nurse

3 days ago

Manila, National Capital Region, Philippines Global Group Innovative Services Full time ₱543,000 - ₱600,000 per year

Job Summary

We're hiring PH Registered Nurses (Client Insurance) to collaborate with healthcare providers and members to ensure quality, medically appropriate, and cost-effective care.

You'll assess inpatient and outpatient medical necessity, coordinate discharge planning, and support utilization management and appeals review.

Responsibilities

  • Evaluate medical claims and benefits for accuracy and completeness
  • Collaborate with Clinical Reviewers and Medical Directors to ensure proper treatment settings
  • Conduct pre-certification, continued stay, and discharge reviews
  • Ensure compliance with clinical guidelines and accreditation standards
  • Support member care transitions through effective case coordination

Qualifications

  • Bachelor's Degree in Nursing or related field
  • Active and unrestricted PHRN license (required)
  • 2 years of BPO clinical experience (UM, Appeals, Denials preferred)
  • Strong communication, problem-solving, and analytical skills
  • Amenable to onsite work in Bridgetowne, Quezon City

Compensation Package

  • ₱43,762 base rate + ₱5,000 program allowance + ₱2,000 non-taxable allowance
  • ₱50,000 total monthly compensation
  • ₱50,000 SIGN-ON BONUS for candidates available to start by November 18, 2025
  • HMO, night differential, paid leaves, and promotion pathways

Apply Now

Be part of one of the top healthcare BPO teams in the Philippines

Job Types: Full-time, Permanent

Pay: Php45, Php50,000.00 per month

Experience:

  • PHRN Healthcare TL: 1 year (Preferred)
  • PHRN Healthcare: 2 years (Preferred)
  • Hospital: 2 years (Required)

Work Location: In person

  • PHRN w/ Prior Auth or Appeals

    7 days ago

    Manila, National Capital Region, Philippines Global Group Innovative Services, Inc. Full time ₱48,000 - ₱52,000 per year

    URGENTLY Needing 80 PHRNS with Prior Auth or Appeals and Denials or any BPO Healthcare Experience.Urgently needing 2 PHRN for Bridgetown QCwho can start ASAP - with Signing Bonus to be discussed over the phone50, % night diffWork onsite in Bridgetown QCwith 1 year BPO Prior Auth, appeals or denials experience.for Ortigas SiteURGENTLY needing PHRNS with BPO...

  • Clinical Denials

    7 days ago

    Manila, National Capital Region, Philippines MicroSourcing Full time ₱2,000,000 - ₱2,500,000 per year

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

  • Clinical Denials

    7 days ago

    Manila, National Capital Region, Philippines MicroSourcing Full time ₱1,500,000 - ₱2,500,000 per year

    Discover your 100% YOU with MicroSourcingPosition: Clinical Denials & Appeals ManagerLocation: TaguigWork setup & shift: Onsite | Night shiftWhy join MicroSourcing?You'll have:Competitive 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, and...

  • Clinical Denials

    2 weeks ago

    Manila, National Capital Region, Philippines MicroSourcing Full time ₱900,000 - ₱1,200,000 per year

    Discover your 100% YOU with MicroSourcingPosition: Clinical Denials & Appeals QA SpecialistLocation: TaguigWork setup & shift: Onsite | Night shiftWhy join MicroSourcing?You'll have:Competitive 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...

  • Clinical Denials

    7 days ago

    Manila, National Capital Region, Philippines MicroSourcing Full time ₱1,200,000 - ₱2,400,000 per year

    Discover your 100% YOU with MicroSourcingPosition: Clinical Denials & Appeals TrainerLocation: TaguigWork setup & shift: Onsite | Night shiftWhy join MicroSourcing?You'll have:Competitive 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, and...

  • PHRN Quality Analyst

    2 weeks ago

    Manila, National Capital Region, Philippines PMConsulting Full time ₱800,000 - ₱1,200,000 per year

    The Quality Analyst will play a crucial role in ensuring the quality of services provided in our Utilization Management, Clinical Denials, and Appeals accounts. The ideal candidate must be a Licensed Nurse with at least 2 years of relevant experience, responsible for monitoring calls and cases, analyzing performance metrics, and providing feedback to improve...

  • Clinical Appeals Writer

    7 days ago

    Manila, National Capital Region, Philippines TapTalent Full time ₱600,000 - ₱800,000 per year

    We're Hiring: Clinical Appeals Writer Viventis Search Asia is working with a leading provider of technology-driven solutions that transform the patient experience and financial performance of healthcare providers. They are currently looking for talented Clinical Appeals Writer professionals to join their team in January 2025.Location: PhilippinesShift: WFH;...

  • Non-Voice Registered Nurse

    1 day ago

    Manila, National Capital Region, Philippines Access Healthcare Full time ₱30,000 - ₱60,000 per year

    Access Healthcare is looking for Registered Nurse to join our growing team.You'll be ensuring the completion of assigned patient cases by doing roll calls, processing concurrent and retro clinical reviews, work processing surgery authorizations, as needed.Qualifications:Registered Nurse with Active license.Hospital Bedside experience (ER, ICU, Post Surgery,...

  • Clinical Appeals Author

    1 day ago

    Manila, National Capital Region, Philippines R1 RCM Full time ₱300,000 - ₱600,000 per year

    LOOKING FOR FILIPINO CANDIDATES RESIDING IN THE PHILIPPINES.We are hiring forClinical Appeals WriterQualifications:Basic Clinical Appeals writing experienceAt least 1+ years of Clinical / Hospital Experience.BS Nursing graduate.With an active PHRN / USRN LicenseStrong familiarity with using EMR/EHR (Electronic Medical Records or Electronic Health...

  • PHRN – Healthcare Account

    1 day ago

    Manila, National Capital Region, Philippines GGIS - Global Group Innovative Services Full time ₱280,000 - ₱600,000 per year

    Ready to take your nursing career to the next level? Join one of the leading healthcare accounts in the country Whether your strength is bedside care, clinical support, or BPO healthcare, we have a spot for you.1 — PHRN (Registered Nurse) | Critical Care AccountLocation: Taguig City or MakatiWork Setup: Hybrid | Graveyard Shift | US HolidaysSalary Range:...