Overview

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
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