Remote Clinical Appeals Specialist (PHRN) – InterQual/MCG Expert

Concentrix Philippines; Quezon City; Remote; PHP 500,000 - 800,000; Full time

Benefits offered by this job

Remote work setup

HMO

Government-mandated benefits

Job summary

Concentrix Philippines is seeking a clinical appeals specialist (PHRN) to review, process, and resolve appeals in line with NCQA, CMS, and client guidelines. You will ensure timely, clinically sound determinations, and support member communications and documentation for payor programs.

The role requires BS Nursing, active PHRN license, and at least 1 year with InterQual/MCG, plus 2 years bedside ICU/CCU/ER experience, in a remote-friendly setup.

Qualifications

• Education: Graduate of BS Nursing.
• License: Active PHRN License.
• Experience: 1 year in InterQual or MCG.
• Clinical: 2 years bedside in ICU/CCU/ER.
• Tech: Stable internet and home office for WFH.

Responsibilities

• Apply InterQual or MC&G to determine medical necessity.
• Coordinate with providers to ensure documentation supports care level.
• Maintain high accuracy and productivity in a remote environment.

Skills

InterQual/MCG

Nursing

Communication

WFH setup

Education

BS Nursing

Job description

Concentrix Philippines is seeking a clinical appeals specialist (PHRN) to review, process, and resolve appeals in line with NCQA, CMS, and client guidelines. You will ensure timely, clinically sound determinations, and support member communications and documentation for payor programs.

The role requires BS Nursing, active PHRN license, and at least 1 year with InterQual/MCG, plus 2 years bedside ICU/CCU/ER experience, in a remote-friendly setup.