PHRN Clinical Review Nurse - Claims & Telehealth

HRTX; Metro Manila; On-site; PHP 600,000 - 900,000; Full time

Job summary

HRTX is seeking a Philippine-licensed Registered Nurse (PHRN) Associate to join our healthcare support team in Metro Manila. You will support utilization management, medical reviews, claims processing, or telehealth services per account, leveraging clinical background in a corporate/BPO setting.

The role suits nurses looking to move beyond bedside care, with responsibilities including reviewing records, conducting medical necessity reviews, and collaborating with teams to ensure accurate

Qualifications

• Must be a Philippine Registered Nurse (PHRN) with an active PRC license.
• At least 12 years of clinical or hospital experience preferred (varies by client).
• BPO or healthcare account experience is a plus.
• Strong English communication skills (verbal and written).
• Proficient in using computers, EHR systems, and basic MS Office tools.

Responsibilities

• Review and assess medical records, insurance claims, or clinical documentation.
• Conduct medical necessity reviews based on standard protocols and guidelines.
• Provide support to healthcare professionals, members, or insurance partners via phone, email, or chat.
• Collaborate with teams to ensure accurate, timely, and efficient processing of healthcare tasks.
• Maintain patient confidentiality and comply with data protection regulations.
• Stay updated on healthcare policies, procedures, and compliance requirements.

Skills

PHRN license

Strong English

EHR systems

MS Office

BPO/Healthcare exp

Job description

HRTX is seeking a Philippine-licensed Registered Nurse (PHRN) Associate to join our healthcare support team in Metro Manila. You will support utilization management, medical reviews, claims processing, or telehealth services per account, leveraging clinical background in a corporate/BPO setting.

The role suits nurses looking to move beyond bedside care, with responsibilities including reviewing records, conducting medical necessity reviews, and collaborating with teams to ensure accurate