PHRN - Utilization Nurse

10 hours ago

Taguig, National Capital Region, Philippines AUMTREND PH INC Full time ₱900,000 - ₱1,200,000 per year

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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