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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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