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John Charles Natividad

@johncharlesnatividad

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Authorization/Appeal Nurse at Cognizant who reviewed medical necessity and finalized appeal outcomes.

Philippines

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What I'm looking for

I’m seeking a role in healthcare, administration, or customer service where I can apply my nursing, authorization, insurance verification, and billing experience. I’m equipped for HIPAA-compliant remote work.

At Cognizant Technology Solutions Philippines, Inc., I reviewed medical necessity for drug testing, genetic testing, and sleep studies using InterQual criteria. I also coordinated with providers and Medical Directors on authorization and appeal cases and documented appeal outcomes.

At Omega Healthcare Management Services, Inc., I verified patient eligibility and network status, reviewed injectable drug authorizations, and submitted referrals and coordinated infusion appointments in EPIC.

Earlier, I worked as a bedside nurse across medical-surgical units, operating rooms, and COVID wards, and as a customer service and billing representative. I’m a registered nurse licensed in the Philippines and New York, with HIPAA accreditation and training in utilization management.

Experience

Work history, roles, and key accomplishments

Authorization/Appeal Nurse

Cognizant Technology Solutions Philippines, Inc.

Nov 2024 - Jan 2026 (1 year 2 months)

Verified member plan status and coverage for requested services, reviewed medical necessity using InterQual criteria, and coordinated with providers and Medical Directors to resolve complex authorization and appeal cases.

Insurance Verification Prior Authorizations InterQual Guidelines Appeals Processing HIPAA compliance EMR Documentation Coordination

Nurse / Authorization Verification

Omega Healthcare Management Services, Inc.

Apr 2023 - Jul 2024 (1 year 3 months)

Verified patient eligibility and network status by liaising with payers, reviewed injectable drug authorizations for coverage, billing, and dosage accuracy, and submitted referrals and coordinated infusion appointments in EPIC EMR.

Insurance Verification Prior Authorizations EMR Billing Support Referrals Coordination

Nurse / EMT

ER Med Ambulance Services

Aug 2022 - Apr 2023 (8 months)

Prepared and maintained ambulance equipment and supplies, assisted with patient transfers, provided assessments and physician endorsements, and delivered timely mission reports to base operations.

Emergency Medical Technician patient assessment Equipment Preparation Reporting

Nurse I / Vaccinator

Department of Health

Nov 2021 - Jul 2022 (8 months)

Administered COVID-19 vaccines in healthcare facilities and city jails, verified patient forms, and prepared vaccination stations.

Vaccination Patient Care Documentation

Staff Nurse

Metro Antipolo Hospital and Medical Center

Jan 2019 - Mar 2021 (2 years 2 months)

Managed 8-10 patients per shift in medical-surgical and specialty wards, served as COVID Nurse for mild to severe cases during 2020, and facilitated patient-doctor communication and treatment compliance.

Medical Surgical Nursing COVID 19 Care Patient Communication Treatment Compliance

Staff Nurse

Far Eastern University – Dr. Nicanor Reyes Medical Foundatio

Aug 2017 - Nov 2018 (1 year 3 months)

Assisted in surgeries and deliveries, maintained sterile environments, transitioned to outpatient minor surgical unit, and managed 8-10 patients per shift in pay wards.

surgical assistance Sterile Technique outpatient care Patient Management

Staff Nurse

Calamba Medical Center

Jan 2017 - Apr 2017 (3 months)

Independently managed 8-15 patients per shift across multiple specialties and liaised between patients and doctors to ensure continuity of care.

Patient Management Multidisciplinary Care Communication Skills

Customer First Champion / Relocations Rep

Telstra International Philippines, Inc.

Nov 2013 - May 2016 (2 years 6 months)

Managed relocation requests for residential and business customers, promoted to Case Manager overseeing service transitions and interim solutions, and strengthened communication and problem-solving skills in a high-volume environment.

Customer Service Case Management Communication Skills Problem Solving