Posted 17 days ago
PHRN (Taguig) | Hybrid
TaguigHybridFull-time
AI Summary
A PHRN nurse handling back-office healthcare administration, including clinical review of medical records, claims processing, utilization management, and case management liaison.
About this role
Work Setup: Training is full onsite; once in production, 2x a week onsite (Taguig)
Start Date: Sept 15, 2026
Requirements:
- PHRN with Active license
- Must have at least 1 year grievance & case appeals experience
- Back-office (Non-voice)
Responsibilities:
- Clinical Review & Documentation: Analyzing medical records for accuracy, compliance, and appropriateness of care.
- Claims Processing: Determining patient eligibility, validating medical claims, and managing insurance coverage.
- Utilization Management: Reviewing treatment plans against medical policies to ensure cost-effective care.
- Case Management & Liaison: Communicating with healthcare providers and patients to facilitate care and resolve inquiries.
Skills
Back-office OperationsCase ManagementClaims ProcessingClinical DocumentationGrievance & Case AppealsHealthcare ComplianceInsurance Eligibility VerificationMedical Records ReviewPHRNUtilization Management
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