Night Shift Clinical Denials & Utilization Supervisor

MicroSourcing; Taguig; On-site; PHP 900,000 - 1,300,000; Full time

Benefits offered by this job

Healthcare coverage day one

Performance bonus

Paid time-off

Job summary

MicroSourcing seeks a Utilization & Denials Management Supervisor to lead UR, denials, and appeals teams on-site in BGC, Taguig City, during the night shift. The role focuses on maintaining SLA/KPI performance, backlog prevention, and compliance with payer regulations.

Ideal candidates hold a BS Nursing with active PHRN/USRN, 1+ year of supervisory experience in utilization management, and strong English communication. Proficiency with EMRs like Epic, Cerner, or Meditech is preferred.

Qualifications

• Bachelor of Science in Nursing with active PHRN or USRN license.
• 1+ year supervisory experience in utilization management or clinical denials.
• 3–5 years acute care hospital experience (Med/Surg preferred) or 2–3 years ICU experience.
• Strong understanding of InterQual or MCG guidelines and US healthcare regulations.
• Experience with EMRs such as Epic, Cerner, or Meditech.
• Excellent English communication skills (CEFR B2).

Responsibilities

• Supervise and support Clinical Denials, Appeals, and Utilization Review 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

English communication

Leadership

Process improvement

Analytical thinking

Education

B.S. in Nursing (active PHRN/USRN)

Tools

Epic/Cerner/Meditech

Job description

MicroSourcing seeks a Utilization & Denials Management Supervisor to lead UR, denials, and appeals teams on-site in BGC, Taguig City, during the night shift. The role focuses on maintaining SLA/KPI performance, backlog prevention, and compliance with payer regulations.

Ideal candidates hold a BS Nursing with active PHRN/USRN, 1+ year of supervisory experience in utilization management, and strong English communication. Proficiency with EMRs like Epic, Cerner, or Meditech is preferred.