Clinical Authorization Nurse – Onsite, Night Shift

Go-Get Data Consultancy; Taguig; On-site; PHP 502,200 - 558,000; Full time

Job summary

A healthcare consulting firm in Taguig is looking for a PHRN – Clinical Authorization specialist. This role involves verifying insurance eligibility, managing authorizations for medical services, and documentation of medical necessity. Candidates should have a BS Nursing degree and at least 6 months of relevant experience. This opportunity is onsite with a night shift schedule and a competitive salary package.

Qualifications

• Active PHRN license preferred but not required.
• At least 6 months of experience in Clinical or Prior Authorization.
• Familiarity with medical necessity guidelines or criteria.

Responsibilities

• Contact insurance carriers to verify patient’s insurance eligibility.
• Request and track pre-authorization from insurance carriers.
• Review and secure authorizations for high-cost oncology drugs.

Skills

Verification of patient’s insurance eligibility

Pre-authorization processes

Medical necessity documentation

Knowledge of medical terminology

High proficiency in general medical office procedures

Education

BS Nursing degree

Tools

EPIC or any Electronic Health Record

Job description

A healthcare consulting firm in Taguig is looking for a PHRN – Clinical Authorization specialist. This role involves verifying insurance eligibility, managing authorizations for medical services, and documentation of medical necessity. Candidates should have a BS Nursing degree and at least 6 months of relevant experience. This opportunity is onsite with a night shift schedule and a competitive salary package.