Hiring Alert: PHRN (Temporary WAH)

<p><strong>Job Summary</strong></p><p><span>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.</span></p><p><br></p><p><br></p><p><strong>Qualifications</strong></p><p><span>•      </span><span>Active PHRN (Philippine Registered Nurse) license, in good standing</span></p><p><span>•      </span><span>Minimum of 1 year of bedside care experience in an acute care setting (clinic-based experience does not qualify)</span></p><p><span>•      </span><span>Minimum of 1 year of experience handling clinical appeals for Inpatient Denials and Utilization Review (UR), specifically Inpatient and Continued Stay Reviews</span></p><p><span>•      </span><span>At least 1 year of hands-on experience using InterQual criteria</span></p><p><br></p><p><br></p><p><strong>Core Responsibilities</strong></p><p><span>•      </span><span>Review and prepare clinical appeals for inpatient denials in accordance with payer and regulatory requirements</span></p><p><span>•      </span><span>Conduct utilization review for inpatient admissions and continued stay reviews</span></p><p><span>•      </span><span>Apply InterQual criteria to support medical necessity determinations</span></p><p><span>•      </span><span>Collaborate with the clinical and case management team to gather supporting documentation for appeals</span></p><p><span>•      </span><span>Maintain accurate and timely documentation of all review and appeal activities</span></p><p><br></p><p></p><span></span><p><strong>Work Setup</strong></p><p><span>•      </span><span>Temporary, work-at-home (WAH) position</span></p><p><span>•      </span><span>Candidate must have a reliable internet connection and a quiet home workstation suited for clinical documentation work</span></p>

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