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