PHRN Team Leader | Healthcare BPO | Registered Nurse | UMR

Private Advertiser; Pasay; Remote; PHP 670,000 - 1,004,000; Full time

Job summary

Private Advertiser is seeking a PHRN Team Lead to oversee a team of Utilization Review Nurses in providing medical necessity reviews for U.S. clients. The role requires strong clinical knowledge, UR experience, and the ability to motivate a remote team.

The position involves supervising UR staff, ensuring QA and regulatory compliance, and coordinating workflow to maintain staffing coverage for night shifts and U.S. operations.

Qualifications

• Active PH Registered Nurse license and 3+ years in clinical setting.
• 2+ years in UM/UR
• 2+ years in supervisory/leadership role in BPO or healthcare ecology

Responsibilities

• Supervise and mentor a team of PHRN Utilization Review Nurses.
• Monitor team productivity, quality, and compliance with client and regulatory guidelines.
• Assist in pre-service, concurrent, and post-service medical necessity reviews as needed.
• Ensure accurate and timely completion of utilization reviews using MCG, InterQual, or client-specific criteria.
• Serve as the first point of escalation for clinical and operational issues.
• Coordinate daily workflow, assign tasks, and ensure adequate staffing coverage.
• Review audit findings and coach team members for continuous improvement.
• Participate in onboarding, training, and upskilling of new hires and existing team members.
• Collaborate with the Operations Manager and Clinical Director for reporting and strategic planning.

Skills

Leadership

Communication

Problem-solving

Decision-making

Team supervision

Time management

Tools

EMR

Utilization Review Platforms

Job description

We are looking for a PHRN Team Lead to oversee and support a team of Utilization Review Nurses in providing high-quality medical necessity reviews for our U.S. healthcare clients.

This leadership role requires strong clinical knowledge, hands-on UR experience, and the ability to guide and motivate a team in a fast-paced, remote work environment.

Key Responsibilities:

• Supervise and mentor a team of PHRN Utilization Review Nurses.

• Monitor team productivity, quality, and compliance with client and regulatory guidelines

• Assist in conducting pre-service, concurrent, and post-service medical necessity reviews as needed.

• Ensure accurate and timely completion of utilization reviews using MCG, InterQual, or client-specific criteria.

• Serve as the first point of escalation for clinical and operational issues.

• Coordinate daily workflow, assign tasks, and ensure adequate staffing coverage.

• Review audit findings and coach team members for continuous improvement.

• Participate in onboarding, training, and upskilling of new hires and existing team members.

• Collaborate with the Operations Manager and Clinical Director for reporting and strategic planning.

Qualifications:

• Active Philippine Registered Nurse (PHRN) license

• At least 3 years of clinical experience in a hospital or acute care setting

• Minimum of 2 years in Utilization Management/Review (UM/UR)

• At least 2 years in a supervisory or leadership role within a BPO or healthcare setting

• Proficient in using EMR and utilization review platforms

• Strong communication, problem-solving, and decision-making skills

• Willing and able to work night shifts to support U.S. operations