Clinical Denials & Utilization Lead

MicroSourcing; Philippines; On-site; PHP 900,000 - 1,500,000; Full time

Job summary

MicroSourcing in the Philippines seeks a Utilization & Denials Management Supervisor for onsite night shifts in BGC, Taguig City. You will oversee daily production, clinical review processes, and quality functions to improve efficiency and compliance.

Lead UR staff, monitor workflows to meet SLAs/KPIs, drive denials reduction, conduct audits, and collaborate with HIM, Coding, and Billing teams to optimize clean claim generation and system performance.

Qualifications

• Supervisory Experience: At least 1 year in utilization management and/or clinical denials and appeals supervision
• Clinical Experience: 3–5 years acute care hospital experience (Med/Surg preferred) or 2–3 years ICU experience
• Education & License: Bachelor of Science in Nursing with active PHRN or USRN license
• RCM Knowledge: Strong understanding of InterQual or MCG guidelines and US insurance and government healthcare regulations
• Systems: Experience with EMRs such as Epic, Cerner, or Meditech
• Communication: Excellent English communication skills (minimum CEFR B2)

Responsibilities

• Supervise and support Clinical Denials, Appeals, and Utilization Review (UR) staff, including hiring, onboarding, and performance management
• Monitor daily workflows to ensure SLAs and KPIs are met, reallocating tasks to manage high‑risk cases and prevent backlogs
• Implement process improvements to reduce denials, write‑offs, and clinical inefficiencies
• Conduct audits and quality reviews to ensure compliance with payer regulations and clinical standards
• Collaborate with HIM, Revenue Integrity, Coding, and Billing teams to ensure clean claim generation and system optimization
• Report team performance in operations meetings and provide ongoing education on documentation updates and audit findings
• Coordinate with healthcare professionals to ensure accurate and timely clinical documentation

Skills

Supervisory experience

Clinical denials/appeals

English communication (CEFR B2)

Education

Bachelor of Science in Nursing

Active PHRN or USRN license

Tools

Epic

Cerner

Meditech

Job description

Discover your 100% YOU with MicroSourcing!

Position: Utilization & Denials Management Supervisor

Location: BGC, Taguig City

Work setup & shift: Onsite, Night shift

Why join MicroSourcing?

Competitive Rewards

Enjoy above-market compensation, healthcare coverage on day one for you and your dependents, paid time-off with cash conversion, group life insurance, and performance bonuses.

A Collaborative Spirit

Be part of a positive and engaging work environment through company-sponsored events and activities.

Work-Life Harmony

Experience a balance that suits your lifestyle with flexible work arrangements.

Career Growth

Access continuous learning opportunities and career advancement.

Inclusive Teamwork

Join a diverse and inclusive workplace that values every individual’s contribution.

Your Role

As a Utilization & Denials Management Supervisor, you will oversee daily production, clinical review processes, and quality functions to ensure operational efficiency and compliance.

You Will

• Supervise and support Clinical Denials, Appeals, and Utilization Review (UR) staff, including hiring, onboarding, and performance management
• Monitor daily workflows to ensure SLAs and KPIs are met, reallocating tasks to manage high-risk cases and prevent backlogs
• Implement process improvements to reduce denials, write-offs, and clinical inefficiencies
• Conduct audits and quality reviews to ensure compliance with payer regulations and clinical standards
• Collaborate with HIM, Revenue Integrity, Coding, and Billing teams to ensure clean claim generation and system optimization
• Report team performance in operations meetings and provide ongoing education on documentation updates and audit findings
• Coordinate with healthcare professionals to ensure accurate and timely clinical documentation
  
  

Non-negotiables

What You Need

• Supervisory Experience: At least 1 year in utilization management and/or clinical denials and appeals supervision
• Clinical Experience: 3–5 years acute care hospital experience (Med/Surg preferred) or 2–3 years ICU experience
• Education & License: Bachelor of Science in Nursing with active PHRN or USRN license
• RCM Knowledge: Strong understanding of InterQual or MCG guidelines and US insurance and government healthcare regulations
• Systems: Experience with EMRs such as Epic, Cerner, or Meditech
• Communication: Excellent English communication skills (minimum CEFR B2)
  
  

Preferred Skills

• Education: Master’s degree or related healthcare/business qualification
• Certification: Case management or clinical appeals/denials certification (e.g., ACMA)
• Leadership: Proven ability to lead in a matrixed environment and influence stakeholders
• Technical Skills: Proficiency in tracking tools for authorizations and Microsoft Office Suite
• Soft Skills: Strong analytical thinking, sound judgment, and decision-making abilities
  
  

About MicroSourcing

With over 9,000 professionals across 13 delivery centers, MicroSourcing is the Philippines’ pioneer and largest offshore provider of managed services.

We believe our strength lies in our people. Our commitment to 100% YOU means fostering a culture that values diversity, inclusion, and authenticity. Here, individuality is celebrated, and growth is supported.

Join us in celebrating YOU and your 100%.

For more information, visit https://www.microsourcing.com/

Terms & conditions apply