clinical authorization

OverviewJob title: PHRN – Clinical AuthorizationWork set up: Onsite Opportunity – MCK Taguig, Cyber Sigma BuildingWork schedule: Weekdays Night Shift schedule, Fixed Weekends OffSalary: 45K to 50K package if licensed PHRN, salary for approval if non-licensedResponsibilitiesContact insurance carriers to verify patient’s insurance eligibility, benefits...

A healthcare consulting firm in Taguig is looking for a PHRN – Clinical Authorization specialist. This role involves verifying insurance eligibility, managing authorizations for medical services, and documentation of medical necessity. Candidates should have a BS Nursing degree and at least 6 months of relevant experience. This opportunity is onsite with a...

AGS Health Philippines, Inc. is seeking a qualified Utilization Review professional in the Philippines to verify insurance eligibility, obtain pre-authorizations, and review high-cost oncology treatments.The role requires a PHRN license and prior experience in utilization review or clinical authorization, with strong HIPAA knowledge and meticulous...

The PH Registered Nurse role at Shearwater Health in Taguig is designed to ensure quality care and efficient processing of client requests. You will coordinate department processes and perform routine service authorizations through telephone and online channels.Ideal candidates hold an active Philippine nursing license, have at least 6 months of bedside...

This job reviews requests for medication coverage determination for prior authorization review and appeals. Through the Utilization Review system, the Pharmacist for Utilization Management evaluates clinical information provided by the physician against medical policy criteria. The incumbent then uses his/her clinical knowledge compared to the policy and...

DME Service Solutions in the US seeks a Pharmacist for Utilization Management to review prior authorizations and appeals, applying medical policy criteria and CMS guidelines. You will evaluate clinical information provided by physicians and determine coverage determinations.Work includes conducting prospective, concurrent, and retrospective reviews,...

Optum Philippines in Metro Manila is seeking qualified nurses for clinical coverage review roles. Valid USRN and PHRN licenses are required, with at least 1 year of hospital bedside nursing and 1 year of prior authorization review experience. Strong clinical understanding and computer navigation are essential. Join a team that supports member care and...

This job reviews requests for medication coverage determination for prior authorization review and appeals. Through the Utilization Review system, the Pharmacist for Utilization Management evaluates clinical information provided by the physician against medical policy criteria. The incumbent then uses his/her clinical knowledge compared to the policy and...

Tata Consultancy Services in Taguig, Philippines seeks licensed nurses for behavioral health prioritization roles, focusing on psychiatric medication prior authorizations and care coordination. The role emphasizes accurate documentation, patient interactions, and timely processing in a fast-paced setting.The candidate will gather and verify clinical data,...

A healthcare service provider is looking for an administrative and clinical support professional in Quezon City. The role involves managing electronic medical records, processing medication authorizations, and scheduling patient appointments. Ideal candidates should be graduates of related healthcare courses and possess strong communication and...

Optum Philippines in Metro Manila is seeking qualified nurses for clinical coverage review roles. Valid USRN and PHRN licenses are required, with at least 1 year of hospital bedside nursing and 1 year of prior authorization review experience. Strong clinical understanding and computer navigation are essential.Join a team that supports member care and...

The PH Registered Nurse role at Shearwater Health in Taguig is designed to ensure quality care and efficient processing of client requests. You will coordinate department processes and perform routine service authorizations through telephone and online channels. Ideal candidates hold an active Philippine nursing license, have at least 6 months of bedside...

DescriptionAbout the RoleWe are seeking a highly skilled Surgical & Clinical Care Coordinator with a clinical background in Nursing, Physical Therapy, or Podiatry. This role combines clinical knowledge with technical revenue cycle expertise—specifically reading physician orders, identifying correct CPT codes, securing prior authorizations, and coordinating...

About the RoleWe are seeking a highly skilled Surgical & Clinical Care Coordinator with a clinical background in Nursing, Physical Therapy, or Podiatry. This role combines clinical knowledge with technical revenue cycle expertise—specifically reading physician orders, identifying correct CPT codes, securing prior authorizations, and coordinating end-to-end...

Experience these exceptional benefits when you join Med-Metrix! 8-Hour Shifts, Fixed Weekends Off Day 1 HMO with 2 of your dependents covered for FREE Group Life Insurance Medical Cash Allowance Rice Allowance Clothing Allowance Holiday Gift Bereavement Assistance Free Lunch Daily Paid Time Off Training and Staff Development Employee Engagement...

Insurance Authorization SpecialistJob Type:Full-Time Work Hours:Monday to Friday, 9:00 AM to 6:00 PM Pacific Time, with a 1-hour breakJob Overview: We are seeking an experiencedInsurance Authorization Specialistwith hands-on experience processingHMO authorizations and prior authorizations , both of which are required for this role. The ideal candidate will...

Our US partner is one of the leading Medical Digital Imaging Service Providers in New Jersey. They offer a full spectrum of diagnostic imaging services in comfortable, convenient, and friendly outpatient imaging centers. As a Prior Authorization Specialist, you are responsible for obtaining pre-certifications and pre-authorizations for procedures and...

Insurance Authorization Specialist Job Type: Full-Time Work Hours: Monday to Friday, 9:00 AM to 6:00 PM Pacific Time, with a 1-hour break Job Overview: We are seeking an experienced Insurance Authorization Specialist with hands-on experience processing HMO authorizations and prior authorizations , both of which are required for this role. The ideal...

Position: Clinical/Prior Authorization - Quality Auditor Qualifications: Must hold an active PHRN license (not a USRN license holder)Must have at least solid 4 to 7 years experience in Clinical/Prior Authorization or Utilization ReviewRelevant experience as a Quality Auditor in Clinical Services within a healthcare BPO environment (preferred only, not...

Insurance Authorization SpecialistJob Type: Full-TimeWork Hours: Monday to Friday, 9:00 AM to 6:00 PM Pacific Time, with a 1-hour breakJob Overview: We are seeking an experienced Insurance Authorization Specialist with hands-on experience processing HMO authorizations and prior authorizations, both of which are required for this role. The ideal candidate...