Utilization & Denials Management Supervisor

Manatal; Philippines; On-site; 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

Discover your 100% YOU with MicroSourcing!

Position: Utilization & Denials Management Supervisor

Location: BGC, Taguig City

Work setup & shift: Onsite | Night Shift

Why join MicroSourcing? You'll have:

• Competitive Rewards: Enjoy above-market compensation, healthcare coverage on Day 1, plus one or more dependents, paid time off with cash conversion, group life insurance, and performance bonuses.
• A Collaborative Spirit: Contribute to a positive and engaging work environment by participating in company-sponsored events and activities.
• Work-Life Harmony: Enjoy the balance between work and life that suits you with flexible work arrangements.
• Career Growth: Take advantage of opportunities for continuous learning and career advancement.
• Inclusive Teamwork: Be part of a team that celebrates diversity and fosters an inclusive culture.

Your Role:

As a Utilization & Denials Management Supervisor, you will:

• 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 service level agreements (SLAs), implementing action plans to address performance gaps and prevent operational backlogs.
• Oversee the timely review and resolution of utilization management, clinical denials, and appeals, including escalated at-risk accounts in accordance with client and payer 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 process improvements.
• Develop and present operational reports, KPI scorecards, dashboards, and performance updates to leadership while driving continuous improvement initiatives.
• 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 to support professional growth and operational excellence.

What You Need:

Non-negotiables

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

Preferred skills/expertise

• Master's degree in Business, Healthcare, or a related field.
• ACMA or other Case Management, Clinical Appeals, or Clinical Denials certification.
• Proficiency with authorization, utilization management, denials tracking systems, and the Microsoft Office Suite (Excel, Word, PowerPoint, Outlook, SharePoint).
• Experience creating KPI dashboards, operational scorecards, and client-facing reports.
• Proven ability to lead cross-functional projects, influence stakeholders, and drive continuous process improvement within healthcare revenue cycle operations.

About MicroSourcing

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

Our Commitment to 100% YOU

MicroSourcing firmly believes that our company's strength lies in our people's diversity and talent. We are proud to foster an inclusive culture that embraces individuals of all races, genders, ethnicities, abilities, and backgrounds. We provide space for everyone, embracing different perspectives, and making room for opportunities for each individual to thrive.

At MicroSourcing, equality is not merely a slogan—it's our commitment. Our way of life. Here, we don't just accept your unique authentic self—we celebrate it, valuing every individual's contribution to our collective success and growth. Join us in celebrating YOU and your 100%!