Position: PHRN Appeals & Denials Nurse

Location: Onsite – Bridgetowne, Quezon City

Shift: Night shift (US hours, including holidays)

Salary Package: Up to ₱50,762/month (Basic ₱43,762 + ₱7,000 allowance)

Special Offer: Signing bonus released on first payout for candidates who can start immediately or by December 9, 2025

Target Start Date: December 9, 2025

Headcount: 12 positions

Recruitment Process: 100% Virtual

We are urgently looking for active Philippine Registered Nurses with a solid clinical background and experience in Clinical Appeals & Denials or Utilisation Management in a BPO/CPO setting.

Key Responsibilities:

Handle clinical appeals, denials, and medical necessity reviews

Interpret clinical documentation and apply evidence-based criteria

Manage multiple cases while meeting strict regulatory turnaround times

Document cases accurately and communicate effectively with US payors

Required Qualifications:

Active Philippine Registered Nurse (PHRN) license

At least 1 year of bedside/clinical nursing experience (hospital, clinic, or managed care)

Minimum 6 months of experience in Clinical Process Outsourcing (CPO/BPO) handling Clinical Appeals & Denials, Utilisation Management, or related roles

Strong clinical knowledge in Medical Necessity Review and clinical documentation interpretation

Excellent English communication skills (verbal & written) and attention to detail

Ability to work under pressure and meet tight deadlines

Proficient in MS Office (Word, Excel, Outlook)

Fully amenable to night shift, US holidays, and onsite work in Bridgetowne, QC

Highly Preferred (Big Advantage):

InterQual experience

Handled Medicare Part C or US-based appeals cases

Familiar with CMS guidelines, NCQA, and URAC

Experience using the Appeals Management platforms and Salesforce Health Cloud

If you meet the qualifications and can start by December 9, 2025 or earlier, send your CV immediately with the subject “PHRN Appeals – Dec 9 Start” to david.abulu@gratitudeindia.com. Only shortlisted candidates will be contacted for a virtual interview within 24–48 hours.