Utilization & Denials Management Supervisor | Onsite, Night shift | BGC

MicroSourcing; Taguig; On-site; PHP 900,000 - 1,200,000; Full time

Benefits offered by this job

Healthcare coverage Day 1

Dependent coverage

Paid time off with cash conversion

Group life insurance

Performance bonuses

Job summary

MicroSourcing is seeking an experienced Utilization & Denials Management Supervisor in Taguig. You will lead a team focused on utilization review and denials, ensuring compliance with payer guidelines and high performance. This onsite, night-shift role demands strong leadership and collaboration with Billing and IT teams.

You will drive process improvements, monitor SLAs, and mentor staff while advancing revenue-cycle operations and under the MicroSourcing banner.

Qualifications

• BS in Nursing with active PHRN or USRN license.
• 1+ year supervisory experience in Utilization Management or Denials & Appeals.
• 3–5 years acute care clinical experience in hospital setting.
• Proficiency with InterQual or MCG guidelines and US regulations.
• Experience with EMR systems (Epic, Cerner, Meditech).
• Excellent English communication (CEFR B2).
• Strong leadership and multitasking in a fast-paced healthcare environment.

Responsibilities

• Lead and supervise a team of Utilization Review and Denials & Appeals specialists.
• Monitor productivity, quality, turnaround time and SLAs; address gaps.
• Oversee timely review and resolution of UM, denials, and appeals per guidelines.
• Audit compliance with payer regulations and documentation requirements.
• Analyze denial trends; collaborate with Billing, Coding, HIM, and Revenue teams.
• Develop and present KPI dashboards and leadership updates.
• Collaborate with IT to optimize EMR and denials systems.
• Mentor staff on utilization management and regulatory updates.

Skills

Supervisory experience

InterQual/MCG knowledge

EMR proficiency

English communication

Education

BS in Nursing

Master's degree (preferred)

Tools

Epic

Cerner

Meditech

Microsoft 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%!