Shift: Night shift Work Setup: On-site in Bridgetowne, Quezon City Openings: 1 Start Date: December 31, 2025, or ASAP Recruitment Process: 2 virtual interview processes

Qualifications:

• Bachelor's Degree in Nursing with an active and valid PHRN license


• At least 2 years of experience in utilization management, medical necessity approvals, and denials


• Clinical instructors experience are welcome to apply


• Minimum of 1 to 2 years of experience in a trainer role


• Experience in a hospital setting or other clinical environment/contact center setting


• Familiarity with Medicare rules, regulations, and guidelines, including coverage criteria and coding principles


• Experience in handling appeals, utilization review, or related healthcare management functions


• Excellent verbal and written communication skills for preparing appeal arguments


• Ability to analyze complex medical information and identify relevant clinical issues


• Willingness to work on-site with flexible schedules, including US hours and holidays

7 Key Screening Questions:

1. Do you have an active and valid PHRN license?


2. How many years of experience do you have in utilization management, medical necessity approvals, and denials?


3. How many years of experience do you have in a trainer role?


4. Do you have at least 1 year of experience in a hospital setting, clinical environment, or contact center setting?


5. Are you familiar with Medicare rules, regulations, and guidelines, including coverage criteria and coding principles?


6. Do you have experience in handling appeals, utilization review, or related healthcare management functions?


7. Are you amenable to working on-site in Bridgetowne, Quezon City, with night shifts, US hours, and holidays?