PHRN Nurses | Utilization Management or Clinical Appeals | Denials
ACES
- Pasig City, Metro Manila
- ₱30,000-50,000 per month
- Permanent
- Full-time
- Conducts comprehensive reviews of utilization data, including claims, authorizations, and medical records, to analyze and take appropriate action
- Requests clinical data from patient's attending physician as necessary for re-authorization process.
- Adheres to guidelines and follows protocol in place.
- Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
- Graduate of BS Nursing
- Must be a PH Registered Nurse with active license
- 2 years in utilization management, clinical appeals, clinical denials or pre-authorization in a US BPO or local healthcare setting
- Computer literate and able to navigate systems with ease
- Above average English communication skills (for Blended or Non-voice positions)
- Amenable to work on night shift schedule (fixed weekends off)
- Willing to work in Ortigas, Pasig
- Basic pay and allowances P30,000 to P50,000 depending on qualifications and experience
- Night differential pay
- Holiday pay
- Health Insurance and Life Insurance benefits
- Medical / Health Insurance
- Paid Sick Leave
- Performance Bonus
- Recruitment / Signing Bonus
- Paid Holidays
- Paid Vacation Leave
- Maternity & Paternity Leave
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