Hiring Alert: PHRN (Temporary WAH)

Job Summary

We are looking for a licensed Philippine Registered Nurse (PHRN) to join our team on a temporary work-from-home basis, supporting clinical appeals for inpatient denials and utilization review. The ideal candidate brings hands-on acute care experience alongside a strong background in inpatient denial appeals, continued stay reviews, and InterQual-based medical necessity determinations.

Qualifications

• Active PHRN (Philippine Registered Nurse) license, in good standing
• Minimum of 1 year of bedside care experience in an acute care setting (clinic-based experience does not qualify)
• Minimum of 1 year of experience handling clinical appeals for Inpatient Denials and Utilization Review (UR), specifically Inpatient and Continued Stay Reviews
• At least 1 year of hands-on experience using InterQual criteria
  
  

Core Responsibilities

• Review and prepare clinical appeals for inpatient denials in accordance with payer and regulatory requirements
• Conduct utilization review for inpatient admissions and continued stay reviews
• Apply InterQual criteria to support medical necessity determinations
• Collaborate with the clinical and case management team to gather supporting documentation for appeals
• Maintain accurate and timely documentation of all review and appeal activities
  
  

Work Setup

• Temporary, work-at-home (WAH) position
• Candidate must have a reliable internet connection and a quiet home workstation suited for clinical documentation workjk