We are seeking experienced Registered Nurses with a background in healthcare BPO operations, specifically in prior authorization processes. The RN will be responsible for reviewing clinical documentation, evaluating medical necessity, and ensuring timely authorization of services according to payer guidelines and client policies.

Key Responsibilities

• Review and process prior authorization requests for medical procedures, medications, and diagnostic tests.
• Evaluate clinical documentation to determine medical necessity and compliance with payer criteria.
• Communicate with physicians, healthcare providers, and insurance representatives to obtain required clinical information.

Qualifications

• Registered Nurse (RN) – active and valid PRC license (PH)
• At least 1 year of BPO experience handling prior authorization, utilization management, or medical review
• Strong understanding of medical terminology, ICD/CPT codes, and US healthcare processes