Utilization & Denials Management 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

Position

Utilization & Denials Management Supervisor

Location

BGC, Taguig City

Work setup & shift

Onsite, Night shift

Key Responsibilities

• Supervise and support Clinical Denials, Appeals, and Utilization Review (UR) 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

Key Requirements

• Supervisory Experience: At least 1 year in utilization management and/or clinical denials and appeals supervision
• Clinical Experience: 3–5 years acute care hospital experience (Med/Surg preferred) or 2–3 years ICU experience
• Education & License: Bachelor of Science in Nursing with active PHRN or USRN license
• RCM Knowledge: Strong understanding of InterQual or MCG guidelines and US insurance and government healthcare regulations
• Systems: Experience with EMRs such as Epic, Cerner, or Meditech
• Communication: Excellent English communication skills (minimum CEFR B2)

Preferred Skills

• Education: Master’s degree or related healthcare/business qualification
• Certification: Case management or clinical appeals/denials certification (e.g., ACMA)
• Leadership: Proven ability to lead in a matrixed environment and influence stakeholders
• Technical Skills: Proficiency in tracking tools for authorizations and Microsoft Office Suite
• Soft Skills: Strong analytical thinking, sound judgment, and decision‑making abilities

Benefits

• Above‑market compensation with healthcare coverage on day one for you and your dependents, paid time‑off with cash conversion, group life insurance, and performance bonuses
• Positive and engaging work environment through company‑sponsored events and activities
• Work‑life harmony with flexible work arrangements
• Continuous learning opportunities and career advancement
• Diverse and inclusive workplace that values every individual’s contribution