PH USRN Authorization Nurse

Gratitude Inc; Taguig; On-site; PHP 446,400 - 669,600; Full time

Job summary

A healthcare solutions provider is seeking a PH USRN Authorization Nurse to handle prior authorization requests in BGC Taguig. The ideal candidate will have a USRN license and experience in utilization management. Responsibilities include reviewing clinical documentation, submitting authorization requests, and coordinating with support staff. Immediate joiners are preferred for this night shift position with a competitive salary package.

Qualifications

• Active USRN license, based in the Philippines.
• Minimum 4 years of experience in utilization management or prior authorization.
• Familiarity with U.S. healthcare and payer systems.

Responsibilities

• Review patient records and provider notes to validate clinical necessity.
• Complete prior authorization forms and submit to payers.
• Follow up on status of submitted requests and escalate delays.

Skills

Utilization Management

Prior Authorization

Strong Communication Skills

Attention to Detail

Education

Active USRN License

Job description

Overview

Job title: PH USRN Authorization Nurse
Work set up: Onsite in BGC Taguig
Work shift: Night shift
Budget: 40K - 60K package (4-6 yrs)

Headcount: 1

Job Description

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

Qualifications

• 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
• Immediate joiners
• Can work onsite in BGC Taguig