Prior Authorization Nurse

About the role

Hive Health is seeking a Prior Authorization Nurse to serve as the primary liaison between members, healthcare providers, and internal HMO teams. In this fast‑paced position you will ensure accurate processing of member availments, issue Letters of Authorization (LOAs) promptly, and handle provider inquiries with professionalism.

Key responsibilities

• Review and adjudicate member availments and claims in line with company policies, HMO guidelines, medical indications, and PhilHealth regulations.
• Prepare, approve, and issue LOAs within established timelines, maintaining complete audit‑ready records.
• Respond to inbound provider calls, delivering accurate information on benefits, availments, and LOAs while meeting daily call‑handling metrics.
• Serve as the main point of contact for providers, coordinating with internal departments to resolve inquiries and track case progress.
• Document all interactions, updates, and outcomes in the appropriate channels and ensure efficient discharge of members.

Required profile

• Willingness to work hybrid in Ortigas and occasional night shifts.
• Familiarity with medical indications for adjudication and relevant Philippine healthcare regulations.
• Prior experience in medical liaison, provider relations, HMO staff, company nursing, or tele‑consult nursing roles.
• Strong problem‑solving abilities, ownership mindset, and excellent verbal and written communication.
• Collaborative team player able to adapt quickly in a fast‑moving environment.

Required skills

What we offer

• Day‑one benefits for full‑time employees, including comprehensive healthcare coverage for you and a dependent.
• Paid time off from the start of employment.
• Mentorship, career development, and continuous learning opportunities.
• Opportunity to contribute to innovative healthcare solutions in the Philippines and beyond.