Job Title: PH USRN Authorization Nurse

Work Setup: Onsite in BGC, Taguig

Work Shift: Night Shift

Compensation Package: PHP 40,000 – 60,000 (based on 4–6 years of experience)

Headcount: 1

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Job Description:

We are seeking a Prior Authorization Nurse (USRN) to join our team in Taguig. The ideal candidate will be responsible for reviewing and submitting prior authorization requests for behavioral health treatments, medications, and services. This role requires meticulous clinical review, documentation, and coordination with support teams to ensure timely and accurate submissions.

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Key Responsibilities:

Review patient records and provider notes to validate clinical necessity

Escalate complex cases to the medical director as needed

Complete and submit prior authorization forms via online portals or fax

Collaborate with administrative staff to collect documentation and verify member benefits

Track the status of submitted requests and escalate delays as necessary

Ensure compliance with documentation standards and turnaround time requirements

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Requirements:

Active USRN license (Philippines-based)

Minimum 4 years of experience in utilization management or prior authorization

Strong knowledge of U.S. healthcare and payer systems

Excellent attention to detail with strong communication and documentation skills

Immediate joiners only

Must not be a current/former employee of the client

Willing and able to work onsite in BGC, Taguig

How to Apply:

Interested candidates who meet the qualifications may submit their updated resume for immediate screening.