PH USRN – Prior Authorization Nurse
Position Summary
The Prior Authorization Nurse (USRN) will support the review and submission of prior authorization requests for behavioral health treatments, medications, or services. The nurse will review clinical documentation to ensure accuracy and medical necessity, complete required payer forms, and work closely with administrative support staff to track and follow up on all submitted requests.
Key Responsibilities
- Review patient records and provider notes to validate clinical necessity
- Escalate cases appropriately to medical director
- Complete prior authorization forms and submit to payers via online portals or fax
- Coordinate with support staff to gather documentation and verify benefits
- Follow up on status of submitted requests and escalate delays appropriately
- Maintain documentation accuracy and compliance with turnaround time requirements
Requirements
- Active USRN license, based in the Philippines
- Minimum 4 years of experience in utilization management, prior authorization
- Familiarity with U.S. healthcare and payer systems
- Detail-oriented with strong communication and documentation skills
Willing to report onsite at Angeles, Pampanga
willing to work on night shift schedule
Job Types: Full-time, Permanent
Pay: Php20,000.00 - Php40,000.00 per month
Schedule:
- 8 hour shift
- Evening shift
- Late shift
- Night shift
Work Location: In person