PH USRN Authorization Nurse, Taguig

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

• 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