Utilization & Denials Management Supervisor

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

Benefits offered by this job

Healthcare coverage Day 1

Paid time off with cash conversion

Group life insurance

Performance bonuses

Job summary

MicroSourcing is seeking a Utilization & Denials Management Supervisor in Taguig City ( onsite | Night Shift ) to lead a UR/Denials team, manage hiring, onboarding, coaching, and performance. You will monitor SLAs, ensure compliant denials processing, and partner with multiple teams to optimize EMR and related systems.

The role requires a BSN with active PHRN/USRN license, 1 year supervisory experience, 3–5 years acute care experience, and proficiency with InterQual/MCG guidelines and EMR

Qualifications

• Bachelor of Science in Nursing with an active PHRN or USRN license.
• 1 year of supervisory experience in Utilization Management and/or Clinical Denials & Appeals.
• 3–5 years of acute care clinical experience (Med/Surg or similar; ICU 2–3 years).

Responsibilities

• Lead and supervise a team of Utilization Review and Clinical Denials & Appeals specialists, including hiring, onboarding, scheduling, coaching, and performance management.
• Monitor team productivity, quality, turnaround time, and SLAs; implement action plans to address gaps and prevent backlogs.
• Oversee timely review/resolution of utilization management, denials, and appeals per client/payer guidelines.
• Conduct audits and quality reviews to ensure compliance with payer regs and documentation requirements.
• Analyze denial trends and coordinate with Billing, Revenue Cycle, Coding, HIM, and related teams for improvements.
• Develop and present operational reports, KPI dashboards, and leadership updates.
• Collaborate with IT and cross-functional teams to optimize EMR and denials management systems.
• Mentor team members on utilization management and regulatory updates.

Skills

Leadership

Coaching

Analytical

Decision-making

English communication

Education

Bachelor of Science in Nursing

Master's degree (preferred)

Tools

Epic

Cerner

Meditech

InterQual/MCG

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%!