Utilization & Denials Lead — Night Shift

Manatal; Philippines; Hybrid; PHP 900,000 - 1,500,000; Full time

Job summary

MicroSourcing in the Philippines is seeking a Utilization & Denials Management Supervisor to lead a team of Utilization Review and Denials specialists onsite in BGC, Taguig City, working night shift. The role focuses on overseeing reviews, denials/appeals, audits, and SLA adherence to client and payer guidelines.

The ideal candidate brings nursing credentials (PHRN/USRN), 1+ year leadership in utilization management, 3–5 years acute care experience, and proficiency with InterQual/MCG guidelines

Qualifications

• BSN with active PHRN or USRN license.
• Minimum 1 year of supervisory experience in Utilization Management/Clinical Denials & Appeals.
• 3–5 years of acute care clinical experience in a hospital setting (Med/Surg or similar; ICU 2–3 years if applicable).
• Proficiency with InterQual or MCG clinical guidelines and strong understanding of U.S. healthcare regulations, utilization management, and revenue cycle processes.
• Experience using hospital-based EMR such as Epic, Cerner, or Meditech.
• Excellent verbal and written English communication skills (CEFR B2).
• Strong leadership, coaching, analytical, and decision-making skills with the ability to manage multiple priorities in a fast-paced healthcare environment.

Responsibilities

• Lead and supervise a team of Utilization Review and Clinical Denials & Appeals specialists, overseeing hiring, onboarding, scheduling, coaching, and performance management.
• Monitor team productivity, quality, accuracy, turnaround time, and SLAs, implementing action plans to address performance gaps and prevent backlogs.
• Oversee timely review and resolution of utilization management, clinical denials, and appeals, including escalated at-risk accounts per guidelines.
• Conduct audits and quality reviews to ensure compliance with payer regulations, utilization management standards, and clinical documentation requirements.
• Analyze denial trends and partner with Billing, Revenue Cycle, Coding, HIM, Revenue Integrity, and Clinical teams to identify root causes and implement improvements.
• Develop and present operational reports, KPI scorecards, dashboards, and leadership updates to drive continuous improvement.
• Collaborate with IT and cross-functional stakeholders to optimize EMR, encoder, utilization management, and denials management systems.
• Mentor and educate team members on utilization management, clinical denials, documentation requirements, regulatory updates, and best practices.

Skills

Leadership

Coaching

Analytical

Decision-making

English Proficiency

InterQual/MCG

EMR (Epic/Cerner/Meditech)

Prioritization

Education

BSN (Bachelor of Science in Nursing)

Tools

EMR: Epic/Cerner/Meditech

MS Office

Job description

MicroSourcing in the Philippines is seeking a Utilization & Denials Management Supervisor to lead a team of Utilization Review and Denials specialists onsite in BGC, Taguig City, working night shift. The role focuses on overseeing reviews, denials/appeals, audits, and SLA adherence to client and payer guidelines.

The ideal candidate brings nursing credentials (PHRN/USRN), 1+ year leadership in utilization management, 3–5 years acute care experience, and proficiency with InterQual/MCG guidelines