139 Specialist Nurse jobs in the Philippines
Prior Authorization Specialist (PHRN - Registered Nurse)
Posted 23 days ago
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Job Description
We are seeking a detail-oriented and organized Prior Authorization Specialist to join our healthcare team. In this role, you will be responsible for obtaining prior authorizations for medical procedures, diagnostic tests, and medications from insurance providers. You will serve as a key liaison between healthcare providers, patients, and insurance companies to ensure timely and accurate approval of services, helping to minimize delays in patient care.
About the Role
As a Prior Authorization Specialist, your primary responsibilities include reviewing medical documentation and verifying insurance coverage to determine the need for prior authorization for procedures, tests, and prescriptions. You will submit prior authorization requests to insurance carriers, follow up on pending approvals, and ensure all documentation is complete and compliant with payer requirements. In collaboration with healthcare providers and clinical staff, you will gather necessary information to support the authorization process and communicate updates to patients regarding the status of their approvals. Additionally, you will maintain accurate records in the electronic health record (EHR) system, respond to insurance inquiries, appeal denied requests when appropriate, and stay informed on payer policy changes to help reduce authorization delays. Strong attention to detail, knowledge of insurance guidelines, and excellent communication skills are essential for success in this role.
Qualifications:
- Must possess an active PHRN license
- Experience as a Quality Auditor in Clinical Services within a healthcare BPO is preferred; alternatively, 4 to 7 years of focused experience in Clinical Authorization or Utilization Review.
- Proficient in using EPIC, MCG, or InterQual guidelines
Patient Care Specialist
Posted 24 days ago
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Job Description
A Patient Care Specialist acts as a liaison between patients, medical staff, and healthcare providers. They help coordinate patient appointments, assist with medical records, address patient concerns, and ensure a smooth and efficient flow of care. The specialist also helps improve the overall patient experience by providing excellent customer service and ensuring that patients’ needs are met in a timely manner. br>
Key Responsibilities:
1. Patient Interaction & Support:
Patient Intake: Greet patients, collect personal and insurance information, and verify patient details.
Patient Communication: Answer patient inquiries via phone, email, or in person. Provide information about treatments, appointments, insurance, and policies.
Appointment Scheduling: Schedule, reschedule, and confirm patient appointments. Ensure proper coordination of appointments with physicians, specialists, or departments.
Patient Advocacy: Serve as a patient advocate, ensuring their concerns are addressed and that they understand their treatment plans, follow-up needs, and care instructions.
2. Administrative Support:
Medical Records Management: Update and maintain accurate patient records in the electronic health record (EHR) system, ensuring compliance with confidentiality and HIPAA regulations.
Insurance Verification: Verify insurance information, assist with claims, and address any billing questions or issues that may arise.
Data Entry: Enter patient data, treatment information, and other relevant records into the healthcare system for tracking and reporting purposes.
Appointment Reminders: Send reminders for upcoming appointments and follow-up visits via calls, texts, or emails.
3. Patient Education:
Care Instructions: Provide patients with pre- and post-care instructions, explaining procedures, medication regimens, and any other necessary healthcare information.
Health Resources: Direct patients to additional resources such as educational materials, support groups, or healthcare providers based on their needs.
4. Coordination of Care:
Referral Coordination: Assist patients in coordinating referrals to specialists or follow-up appointments as recommended by the healthcare provider.
Test Results & Follow-ups: Help ensure patients receive test results and follow-up instructions promptly. Communicate results to patients as directed by healthcare providers.
Team Collaboration: Work closely with physicians, nurses, medical assistants, and other healthcare professionals to ensure that patients receive comprehensive care and that all aspects of their treatment are coordinated.
5. Billing & Payment Assistance:
Insurance Verification: Confirm patient insurance eligibility, coverage, and benefits before appointments.
Billing Support: Assist patients with billing questions, provide cost estimates for procedures, and help them understand their financial responsibilities for services rendered.
6. Patient Advocacy & Experience:
Patient Comfort: Ensure patients are comfortable and informed during their visits, addressing any concerns or anxieties they may have about their care.
Feedback Collection: Gather patient feedback about their experiences and escalate any unresolved issues or complaints to appropriate staff or management.
7. Compliance & Record-Keeping:
Confidentiality & HIPAA Compliance: Ensure all patient data is kept confidential and handled according to HIPAA regulations.
Health Regulations: Stay updated on health regulations, medical office protocols, and best practices for patient care.
Skills & Qualifications:
Education:
Candidate must be a graduate of any 4-year course
Preferably with at least 1 year of related experience in customer service
Key Skills:
Excellent Communication: Ability to communicate clearly and compassionately with patients, families, and healthcare teams.
Empathy & Compassion: A caring attitude and ability to build rapport with patients and help ease their concerns.
Attention to Detail: Ensure accurate data entry, billing information, and patient records are maintained.
Problem-Solving: Ability to troubleshoot patient concerns, resolve scheduling conflicts, and manage billing issues efficiently.
Organizational Skills: Strong ability to juggle multiple tasks, manage appointments, and ensure smooth operations in a busy healthcare environment.
Knowledge of Healthcare Terminology: Understanding of medical terms, insurance policies, and healthcare practices.
Multitasking: Ability to handle multiple tasks simultaneously, including answering phones, assisting patients, and updating records.
Patient Care Specialist
Posted 28 days ago
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Job Description
The Patient Care Specialist primarily attends to patients and customers in the clinic and performs a variety of tasks to ensure that services are provided in an effective and efficient manner. br>
Requirements:
· Candidate must be a graduateof any 4-year course br>· Preferably with at least 1 year of related experience in customer service br>· Must have excellent verbal communication skills. br>
"6 days a week
Onsite
Clinic Hours: 10:00AM-5:00/7:00PM
1 Day Off (Weekday)"
Patient Care Coordinator
Posted today
Job Viewed
Job Description
PERMANENT WORK FROM HOME. ICU HOSPITAL CHARTING FOR A CLINIC.
8-HR NIGHT SHIFT, WORK WEEKDAYS, 2 DAYS OFF WEEKENDS
FOR ASAP HIRING!
$800 starting salary
**Requirements**:
- ICU, ER or COVID ward experience
- Fast learner
- Excellent communication skills for calls
- Quiet workstation where you can work undisturbed
- Inbound and Outbound calls
- Computer savvy
- The PC should have a minimum Core I5 processor and 8 GB RAM
- Minimum 20 MBPS internet speed
- noise-canceling headset
**Job Types**: Full-time, Permanent
Pay: Php40,000.00 - Php43,000.00 per month
**Benefits**:
- Health insurance
- Paid training
- Pay raise
- Work from home
Schedule:
- 8 hour shift
- Monday to Friday
Supplemental Pay:
- Overtime pay
- Performance bonus
Ph Registered Nurse (Medical Management Specialist)
Posted today
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Job Description
- Primary duties may include, but are not limited to: Reviews, analyzes and renders determinations on requests from the providers and beneficiaries for reconsideration of previously rendered medical decisions relating to claims issues.
**Qualifications**:
- Requires a current Philippines RN license; 4 years of health care experience; or any combination of education and experience, which would provide an equivalent background. Current unrestricted RN license in applicable state(s) as required.
- Must have an Active PRC Nursing License.
- Experience with daily operations in a clinical, managed care, hospital care setting including working with provider systems and medical providers is an advantage.
- Prior Utilization Management or Prior Authorization Clinical Experience is an advantage, but not required.
- Role requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Questions? Chat with us via Facebook Messenger at m.me/LegatohealthPH
**What you can look forward to**:
- Competitive Compensation and Benefits package
- Quarterly Incentive Program*, computed as % from annual gross compensation
- Premium HMO Coverage, covering employee + up to 2 dependents on Day 1 of employment
- Vacation and sick leaves with annual conversion*
- Weekends off fixed night shift schedule for most lines of businesses
- Retirement package eligibility depending on tenure of employment
- Opportunity to join a paid Training Program and potential sponsorship to take the NCLEX and get a USRN license*
*Terms and conditions apply.
**Salary**: Up to Php30,000.00 per month
Schedule:
- 8 hour shift
Supplemental pay types:
- 13th month salary
- Overtime pay
- Quarterly bonus
Ability to commute/relocate:
- Taguig: Reliably commute or planning to relocate before starting work (preferred)
**Education**:
- Bachelor's (preferred)
**Experience**:
- Nursing: 1 year (preferred)
License/Certification:
- Philippine Registered Nurse License (preferred)
Patient Care Support Representative
Posted 7 days ago
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Job Description
For Allied Graduates (with or without license) br>Are you a graduate of Allied Sciences, Social Sciences, Social Work, or Human Services? This is your opportunity to join a healthcare team that values your background and experience.
Qualifications:
Bachelor’s Degree in Allied Sciences, Social Sciences, Social Work, or Human Services < r>
At least 1 year of direct patient care experience in any of the following:
Long-term care
Home or community-based services
Hospital or facility-based care
Case management or managed care organizations
BPO healthcare – member services via phone < r>
Not qualified if experience is limited to:
Pediatric or provider-only care
Email or chat-only interactions
Roles with no direct contact with patients
Compensation and Benefits:
28000 basic salary
1000 flex fund allowance
20 percent night differential
HMO coverage starting on Day 1
HMO coverage for dependents upon certification
Life and accident insurance
13th and 14th month pay
Annual performance-based increase
Apply Now
Send your resume or tag someone who fits the qualifications. This is your chance to be part of a professional and rewarding team in Quezon City.
Patient Care Quality Officer
Posted 8 days ago
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Job Description
br>The Patient Care Quality Officer is responsible for overseeing and improving the quality of patient care provided within the home care setting. The role includes conducting audits, analyzing data, implementing quality improvement initiatives, ensuring compliance with regulatory standards, and collaborating with the clinical service staff to improve patient outcomes.
QUALITY ASSURANCE AUDITS AND REVIEWS
Conduct regular audits remote or on-site, of documentation, patient care, and clinical procedures.
Review patient records to ensure compliance with home care policies, patient care standards, and regulatory requirements.
Monitor and evaluate infection control practices and patient safety protocols.
DATA COLLECTION AND ANALYSIS
Collect and analyze data related to patient outcomes, clinical staff performance, and service quality.
Identify trends, gaps, and areas for improvement in patient care practices.
Prepare reports and present findings to leadership for action planning.
COMPLIANCE MONITORING
Ensure adherence to national and local regulatory requirements.
Assist in preparing the company for accreditation surveys and inspections.
Develop and implement corrective action plans when deficiencies are identified.
STAFF TRAINING AND DEVELOPMENT
Educate clinical service staff on quality assurance standards, patient safety initiatives, and best practices.
Assist in the development of training programs to enhance clinical service competencies and compliance with quality standards.
Provide coaching and mentoring to clinical service staff to improve performance in areas identified through audits and evaluations.
ROCESS IMPROVEMENT
Collaborate with clinical service staff and management to develop and implement quality improvement initiatives.
Lead or participate in multidisciplinary quality improvement teams to improve patient care processes.
Facilitate the implementation of evidence-based practices and protocols to enhance patient outcomes.
PATIENT CARE EVALUATION
Evaluate patient care delivery and outcomes to ensure highquality, patient-centered care.
Address patient and family concerns regarding patient care quality, and work to resolve issues through continuous quality improvement.
DOCUMENTATION AND REPORTING
Maintain comprehensive records of quality assurance activities, audits, and outcomes.
Develop and submit detailed reports on quality assurance findings to nursing leadership and the quality assurance committee.
RISK MANAGEMENT
Identify potential risks to patient safety and implement measures to mitigate those risks.
Collaborate with risk management teams to reduce incidents and improve patient safety.
QUALIFICATIONS
Graduate of any Allied Health Course
Good people skills.
BLS Certified is a plus
Excellent verbal and written communication skills
Willing to work in shifting schedule or extended hours
In-depth knowledge of all procedures used in the management of hospitals or home care organizations
Has the compassion to serve and help patients
Strong MS 365 knowledge.
Job Type: Full-time
Benefits:
Opportunities for promotion
Paid training
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Patient Care Support Representative - QC
Posted 7 days ago
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Job Description
For Non-Allied Graduates or Associate Degree Holders br>Do you have real-world patient care experience but a non-allied degree? We’re looking for dedicated professionals ready to support patients and providers in a healthcare setting. < r>Qualifications:
Associate Graduate or College Graduate from any course
At least 2 years of direct patient care experience in any of the following:
Long-term care
Home or community-based services
Hospital or facility-based care
Case management or managed care organizations
BPO healthcare – member services via phone < r>
Not qualified if experience is limited to:
Pediatric or provider-only services
Email or chat-only work
Roles without direct patient contact
Compensation and Benefits:
28000 basic pay
1000 flex fund allowance
20 percent night differential
HMO coverage starting on Day 1
HMO for dependents after certification
Life and accident insurance
13th and 14th month pay
Annual salary increase based on performance
Patient Care Coordinator - Virtual Assistant
Posted 6 days ago
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Job Description
This is a remote position.
Virtual Rockstar is seeking a Patient Care Coordinator to join our team and support our healthcare partner in managing patient communications. This role plays a key part in ensuring patients feel cared for, informed, and supported throughout their healthcare journey.
About Our PartnerOur healthcare partner is committed to redefining medicine through continuous research, problem solving, and evidence-based practice. They strive for excellence in patient care and safety, utilizing a unique model that integrates cutting-edge technologies with a patient-centered, problem-solving approach. Their specialized focus is on the treatment of sports-related injuries and other musculoskeletal conditions, helping patients recover and thrive with innovative, high-quality care.
ResponsibilitiesHandle patient inquiries via phone, email, and secure messaging.
Coordinate appointment confirmations, rescheduling, and telehealth setup.
Follow up with patients after visits or procedures to check progress and provide support.
Send personalized patient communications, including instructions, reminders, and follow-up messages.
Assist with FAQs and escalate medical concerns to clinical staff as appropriate.
Maintain accurate patient records and documentation within the EMR system.
Ensure patient privacy and confidentiality at all times.
Tools & Systems You’ll UseAthena Health EMR (electronic medical records)
Microsoft 360 Suite (Outlook, Excel, Teams)
Pain log program for patient tracking
RequirementsPrior experience in healthcare administration or patient support is strongly preferred.
Excellent verbal and written English communication skills.
Ability to handle sensitive patient interactions with professionalism and empathy.
Familiarity with EMRs (AthenaHealth experience is a plus).
Strong organizational and multitasking skills.
BenefitsCompetitive salary commensurate with experience.
Opportunities for professional development and growth.
Work in a dynamic and supportive team environment.
Make a meaningful impact by helping to build and strengthen families in the Philippines.
US Nurse Specialist - CSR (Inbound & Outbound) - Work from Home
Posted 2 days ago
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Job Description
(Nurse Specialists typically will work an eight-hour workday. Occasional evenings or weekend hours may be br>required.)
QUALIFICATIONS:
-Must be a Registered Nurse.
-Minimum of 2 years customer service and contact center experience is strongly desired.
-Minimum of 2 years clinical experience.
-Experience with field-based work is also desired.
o Strong written and oral communication skills.
o Customer service focus.
o Ability to work effectively through influence and collaboration.
o Good judgment in managing and escalating client or project issues. Must be able to manage multiple projects and understand contact center processes.
o Excellent interpersonal skills.
o Ability to identify problems, take initiative, and be solution oriented.
RESPONSIBILITIES:
Makes scheduled outbound calls and responds to inbound calls from patients and other customers regarding clinical aspects of a product, product administration, and adherence to medical therapies or treatments or for other related issues. Conducts follow up calls or sends follow up correspondence as necessary according to the program’s guidelines.
ay provide pre-approved medical information or literature to customers based on the guidelines of the specific program. < r> ay conduct /behavioral interviewing and motivational coaching calls with patients to encourage them to be adherent to their medication as prescribed. < r> ocuments adverse events and provides reporting per Fortrea and client policies and procedures < r> ther duties, as assigned.