Clinical Review Nurse

2 days ago


Pasig, National Capital Region, Philippines Connext Global Solutions Inc Full time ₱900,000 - ₱1,200,000 per year
About Connext

Connext is a team of business process outsourcing experts serving world-class clients in industries like Healthcare, Title and Escrow, Retail and Fashion, Produce Distribution, Design Consulting, and Finance.

We are currently hiring a Clinical Review Nurse to work with one of our healthcare clients based in the U.S.


What's in it for you?
  • Competitive compensation
  • Perfect Attendance Bonus
  • HMO and Life Insurance
  • Annual Merit Increase
  • Great company culture
  • 25,000 Php Sign-On Bonus
  • 25% Differential Pay

About the Role

As a Clinical Appeals Nurse, you will conduct comprehensive audits of medical records to support appeals, defense audits, and evaluations of disallowed charges. Your clinical expertise will help determine medical necessity, draft appeal letters, and ensure compliance with regulatory and payer guidelines.


Responsibilities:


• Audit medical records for defense audits, disallowed charges, patient inquiries, and biller-requested reviews

• Apply InterQual, MCG, and Medicare/Medicaid/commercial criteria to assess medical necessity

• Support appeals (ALOS, RAC, CERT, ZPIC, SMRC) and draft clear, clinically sound appeal letters

• Request and compile additional documentation from providers; review relevant clinical literature

• Enter audit findings accurately in client systems; work across EMRs, billing, and quality platforms

• Maintain HIPAA/FDCPA/FCRA compliance, safeguard PHI, and stay current on payer policies and best practices


Qualifications:
  • Registered Nurse (RN) license
  • At least 1 year of experience using InterQual and MCG
  • 3 to 5 years of clinical experience or background in auditing, appeals, utilization review, or denials management
  • Experience in medical records review or claims processing
  • Strong knowledge of Medicare/Medicaid regulations
  • Proficient in EMRs and Microsoft Office

Preferred:
  • Certifications in case management, utilization review, or medical coding
  • Familiarity with EHR, EPIC, InterQual and MCG criteria


  • Pasig, National Capital Region, Philippines VISAYA Full time $40,000 - $60,000 per year

    About Visaya KPO:Visaya Knowledge Process Outsourcing Corporation is a proudly Filipino organization recognized globally for service excellence, innovation, and a culture ofmalasakit. We are committed to building long-term partnerships through quality, reliability, and a people-first approach.Role Overview:We are seeking a skilled Utilization...


  • Pasig, National Capital Region, Philippines Coronis Health Full time ₱1,200,000 - ₱2,400,000 per year

    Company DescriptionAt Coronis Health, we specialize in revenue cycle management (RCM) with a focus on simplifying complexities for healthcare providers to enable them to deliver exceptional patient care. We offer tailored solutions for billing optimization, claims management, and actionable insights to support growth and scalability for each unique practice....

  • Clinical Supervisor

    2 days ago


    Pasig, National Capital Region, Philippines The Medical City Full time ₱2,000,000 - ₱2,500,000 per year

    OverviewThe Medical City Ortigas is seeking a highly motivated and experiencedClinical Nursing Supervisorto join our dynamic healthcare team. This leadership role plays a critical part in ensuring high standards of patient care and nursing practice across assigned clinical units. The successful candidate will assist the department head in strategic and...


  • Pasig, National Capital Region, Philippines Healthcare United Global Solutions (HUGS) Full time ₱250,000 - ₱350,000 per year

    Company Clinic Nurse Duties and Responsibilities:Taking and Monitoring Patient's Vital signsMedical Certificate validationMedicine dispensing with health teachingsUpdating clinic consultation tracker/medicine dispensedAssisting Physician's during medical care and treatmentsProviding patient care as per facility policies and procedures.Documenting patient...

  • Case Manager Nurse

    2 days ago


    Pasig, National Capital Region, Philippines TASQ Staffing Solutions Full time ₱900,000 - ₱1,200,000 per year

    Qualifications:Graduate of BS Nursing, USRN required.At least 1 year previous hospital nursing experience or Case Management experience in a clinical setting for a US-based healthcare company, required.Experience in Prior Authorization, Case Management and Utilization ReviewExperience:Prior Authorization: 1 year (Preferred)Case Management: 1 year...

  • Case Manager Nurse

    2 days ago


    Pasig, National Capital Region, Philippines TASQ Staffing Solutions Full time ₱900,000 - ₱1,200,000 per year

    TASQ is seeking a USRN case manager to join their team in Pasig on-site as soon as possible.The pre-screening interview will be done over the phone. Qualifications: - Bachelor's degree in nursing; a USRN license is mandatory. - A minimum of 1 year of hospital nursing or case management experience within a clinical setting for a US-based healthcare...

  • Nursing Instructor

    4 days ago


    Pasig, National Capital Region, Philippines The Medical City Full time ₱1,200,000 - ₱2,400,000 per year

    The OpportunityThis is not a routine training role. AsClinical Instructorat The Medical City, you will be at the forefront of shaping nursing education, clinical excellence, and professional development across the enterprise.You will design and implement comprehensive educational programs, collaborate with academic institutions, and lead initiatives that...

  • Staff Nurse

    4 days ago


    Pasig, National Capital Region, Philippines The Medical City Full time ₱800,000 - ₱1,200,000 per year

    The Medical City Clinicis searching for aStaff NurseatAyala Malls Felizto join the team and help lead the organization to the next level. This role is responsible for assisting the doctors in administering treatments, monitoring vital signs, handling medical emergencies, and providing critical assistance to patients as needed.This role reports directly to...

  • Staff Nurse

    4 weeks ago


    Pasig, National Capital Region, Philippines The Medical City Full time

    OverviewThe Medical City Clinic Ayala Malls Feliz is seeking a Staff Nurse to join the team and help lead the organization to the next level. This role is responsible for assisting the doctors in administering treatments, monitoring vital signs, handling medical emergencies, and providing critical assistance to patients as needed. This role reports directly...

  • Registered Nurse

    4 days ago


    Pasig, National Capital Region, Philippines Proser Health Services Inc. on behalf of The Medical City Clinic Full time ₱250,000 - ₱500,000 per year

    Proser Health Services Inc. on behalf of The Medical City Clinic is hiring a Full time Registered Nurse role in Pasig, NCR. Apply now to be part of our team.Job summary:Looking for candidates available to work:Monday: Morning, AfternoonTuesday: Morning, AfternoonWednesday: Morning, AfternoonThursday: Morning, AfternoonFriday: Morning, AfternoonSaturday:...