Utilization & Denials Supervisor — Clinical Appeals Lead

Huron; Taguig; Híbrido; PHP 900.000 - 1.200.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Healthcare coverage day one for you &/

Bonus programs

Descripción de la vacante

MicroSourcing is seeking a Utilization & Denials Management Supervisor in Taguig (BGC) for a night shift, onsite. You will oversee daily production, clinical reviews, and quality functions to ensure regulatory compliance and efficient operations.

Key requirements include a BSN with active PHRN/USRN, 1 year supervisory experience in utilization management, and 3–5 years hospital experience or ICU background. EMR familiarity with Epic/Cerner/Meditech is essential.

Formación

• Bachelor of Science in Nursing with active PHRN or USRN license.
• Minimum 1 year supervisory experience in utilization management or denials.
• 3–5 years acute care hospital experience (Med/Surg) or 2–3 years ICU experience.
• Strong knowledge of InterQual or MCG guidelines and US healthcare regulations.
• Experience with EMR systems such as Epic, Cerner or Meditech.

Responsabilidades

• Oversee daily production and clinical review processes for denial management and utilization review.
• Lead staff including hiring, onboarding, and performance management.
• Monitor workflows to meet SLAs and KPIs; reallocate tasks to manage high-risk cases.
• Implement process improvements to reduce denials and inefficiencies.
• Conduct audits and quality reviews to ensure payer compliance and clinical standards.
• Collaborate with HIM, Revenue Integrity, Coding and Billing teams for clean claim generation.
• Report team performance in operations meetings and educate on documentation updates.

Conocimientos

Supervisory Experience

Clinical Denials Management

US Healthcare Regulations

English Communication

Team Coordination

Educación

BSN with active PHRN/USRN

Herramientas

Epic

Cerner

Meditech

Descripción del empleo

MicroSourcing is seeking a Utilization & Denials Management Supervisor in Taguig (BGC) for a night shift, onsite. You will oversee daily production, clinical reviews, and quality functions to ensure regulatory compliance and efficient operations.

Key requirements include a BSN with active PHRN/USRN, 1 year supervisory experience in utilization management, and 3–5 years hospital experience or ICU background. EMR familiarity with Epic/Cerner/Meditech is essential.