PHRN - Utilization Nurse
4 hours ago
Key Responsibilities
- Review patient records and provider notes to validate clinical necessity
- Complete prior authorization forms and submit to payers via online portals or fax
- Follow up on status of submitted requests and escalate delays appropriately
- Maintain documentation accuracy and compliance with turnaround time requirements
- Balance quality of care with cost efficiency
- Compile and review medical information and insurance coverage
- Authorize requested medical services
- Prepare cases for physician review
- Inform patients about their benefits and coverage limits
- Identify alternative, cost-effective resources
Requirements
Active PHRN license
Minimum 2 years of experience in utilization management or triage
Familiarity with U.S. healthcare and payer systems
Detail-oriented with strong communication and documentation skills
Job Type: Full-time
Benefits:
- Health insurance
Ability to commute/relocate:
- Taguig: Reliably commute or planning to relocate before starting work (Preferred)
Application Question(s):
- Notice Period:
- Current and Expected Salary:
License/Certification:
- USRN Certificate (Preferred)
Work Location: In person
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