This one is closed
Live roles like this one
Get new “Philippines AG USRN” roles by email
One email a day with what is new in "Philippines AG USRN". Nothing new, no email.
We confirm the address first, and every mail carries an unsubscribe link. Alerts are ours, not a third party's.
Why this grade This listing scored 54/100, which is a D. It lost the most ground on pay transparency. See the breakdown
- Description depth 20 / 20 How much the posting actually says about the work, measured in characters of real text.
- Freshness 15 / 15 How recently it was posted. Older postings are likelier to be filled or abandoned.
- Remote clarity 8 / 15 Whether "remote" means anywhere, or is quietly restricted to one country.
- Role specificity 6 / 10 Whether the listing is tagged well enough to tell what the role actually is.
- Corroboration 5 / 10 Whether more than one source carries this listing.
- Pay transparency 0 / 25 A published salary range, worth more than any other single factor because it is what a candidate cannot find out without applying.
Every figure above is arithmetic over the posting itself — its salary field, its text, its age, its tags and how many sources carry it. How the grades work →
Mid level Full Time
Overview
USRN - A&G
Taguig, National Capital Region, Philippines
BE THE FIRST TO APPLY
JOB DESCRIPTION
In this role you should independently be able to effectively and efficiently process the transactions assigned in a timely manner, clarify complex transactions to others and ensure that quality of output and accuracy of information is maintained, in alignment with SLAs.
- Investigate and process complex grievances and appeals requests from members and providers
- Perform reviews of inpatient, outpatient, ambulatory and ancillary services for medical necessity
- Review, research, and prepare documentation related to appeals and grievances in accordance with local, state, and federal regulatory and designated accreditation (e.g., NCQA) standards
- Prepare recommendations to either uphold or deny appeal and work with the Medical Director for further review
- Document and logs appeal/grievance information on relevant tracking systems
- Generate written correspondence to providers, members, and regulatory entities
- Serve as a subject matter expert for appeals, grievances, and quality of care issues
- Utilize leadership skills
- Assist with or perform other relevant essential functions as required
Qualifications:
- Unrestricted USRN mainland license
- At least 2 years experience in utilization management / review
- Demonstrated clinical knowledge and experience relative to patient care and healthcare delivery processes. Medicare Advantage experience an advantage
- Excellent written and verbal communication skills.
- Excellent customer service and interpersonal skills.
- Working knowledge of current industry Microsoft Office Suite PC applications.
- Ability to apply clinical criteria/guidelines for medical necessity, setting/level of care, and concurrent patient management
- Knowledge of current standard medical procedures/practices and their application as well as current trends and developments in medicine and nursing, alternative care settings, and levels of service
- Knowledge of applicable accreditation standards, and local, state, and federal regulations
- Appeals and grievance experience required.
- Strong problem-solving skills, facilitation skills, and analytical skills.
- Flexible to work in globally distributed teams and on business need support weekend transactions
Originally posted on Himalayas
Apply for this role Opens himalayas.app — the link as listed; we have not yet verified it is the employer's own page
Quick question · anonymous · one tap
Would you apply to this job?
Answer to see what other job seekers said.
Your turn · no account needed
Help the next applicant
You may know something about this listing that we cannot see from here. One tap. No account needed. Signed-in reports earn points once the evidence agrees with you.
I know what it pays
Sign in with Google to earn points for reports — 100 confirmed points buy a week of Early Access.
Where this listing came from
- 08 Oct 2026 Himalayas first sighting
Seen on 1 board over 0 days.