Clinical Appeals - PHRN

Concentrix; Metro Manila; Remote; PHP 558,000 - 893,000; Full time

Job summary

Concentrix is seeking a licensed RN (PHRN) in Metro Manila for a remote utilization review role. You will apply InterQual or MCG guidelines to determine medical necessity and coordinate with providers to ensure documentation supports the level of care.

The role requires 2+ years bedside experience in ICU/CCU/ER, 1 year InterQual/MCG experience, and a stable home office with reliable internet for a WFH setup.

Remote work environment with performance-driven expectations.

Qualifications

• BS Nursing degree required.
• Active PHRN license.
• At least 1 year experience with InterQual or MCG.
• At least 2 years bedside experience in ICU/CCU/ER.
• Stable internet connection and home office for WFH.

Responsibilities

• Apply InterQual or MCG to determine the medical necessity of requested services.
• Coordinate with healthcare providers to ensure clinical documentation supports the level of care.
• Maintain high accuracy and productivity standards in a remote, fast-paced environment.

Skills

Remote work

Clinical documentation

InterQual/MCG experience

Education

BS Nursing

PHRN License

Tools

InterQual / MCG

Job description

Responsibilities

• Apply InterQual or MCG (Milliman Care Guidelines) to determine the medical necessity of requested services.
• Coordinate with healthcare providers to ensure clinical documentation supports the level of care.
• Maintain high accuracy and productivity standards in a remote, fast-paced environment.

Qualifications

• Education: Graduate of BS Nursing.
• License: Must possess an active PHRN License.
• CPO Experience: At least 1 year of solid experience in InterQual or MCG (Milliman Care Guidelines).
• Clinical Experience: At least 2 years of bedside experience in high-acuity areas:
• ICU (Intensive Care Unit)
• CCU (Critical Care Unit)
• ER (Emergency Room)
• Tech Requirements: Must have a stable internet connection and a conducive home office setup for a WFH arrangement.