USRN BPO | Prior Auth Review Exp in BPO & 1 Yr Hospital Exp| Active PHRN & USRN | WFH | Up to 85K

Job Description

USRN Prior Authorization Review Specialist | Prior Auth Review Experience in a Healthcare BPO | Active PHRN & USRN | WFH | Up to ₱85K Salary Package: ₱65,000–₱85,000 (Depending on your skills, qualifications, relevant experience, and interview results) Employment Type: Full-Time | Permanent Industry: Healthcare Business Process Outsourcing (Healthcare BPO) Work Setup: Work From Home (WFH) Work Location: Cebu (WFH Opportunity) Shift: To Be Announced Start Date: October 22, 2026 About The Role This is a Healthcare Business Process Outsourcing (Healthcare BPO) opportunity supporting U.S. healthcare clients. As a USRN Prior Authorization Review Specialist , you will perform clinical reviews to evaluate prior authorization requests, assess medical documentation, determine medical necessity, and prepare evidence-based clinical recommendations that support authorization decisions. Non-Negotiable Requirements Active Philippine Registered Nurse (PHRN) License Active unrestricted U.S. Registered Nurse (USRN) License Bachelor's Degree in Nursing (BS Nursing) At least 1–3 years of acute hospital bedside experience in any of the following: Medical-Surgical (Med-Surg) Emergency Department (ED) Intensive Care Unit (ICU) At least 1 year of Prior Authorization Review experience in a Healthcare BPO (Non-Negotiable) Experience reviewing medical necessity and authorization requests Strong clinical documentation review and medical record analysis skills Excellent clinical writing, analytical, and critical thinking skills Willing to work 100% Work From Home (WFH) Job Responsibilities Review prior authorization requests and determine medical necessity based on clinical documentation. Evaluate patient medical records and supporting documents for authorization decisions. Prepare detailed, client-facing clinical reviews with evidence-based rationale. Apply client policies and clinical guidelines when making authorization recommendations. Collaborate with physicians, case managers, and healthcare professionals to ensure accurate and timely reviews. Maintain quality, productivity, and turnaround time standards. Ensure compliance with client requirements and regulatory guidelines. Preferred Skills Prior Authorization Review Medical Necessity Review Clinical Documentation Review Healthcare BPO Utilization Management Clinical Writing Acute Care Nursing Medical-Surgical Nursing Emergency Department (ED) Intensive Care Unit (ICU) U.S. Healthcare Pay: Php65,000.00 - Php85,000.00 per hour Benefits Paid training Work Location: Remote