Utilization & Denials Supervisor - Night Shift RN Leader

MicroSourcing

Philippines

On-site

PHP 600,000 - 900,000

Full time

5 days ago

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Job summary

MicroSourcing in the Philippines is seeking a Utilization & Denials Management Supervisor to lead a team of Utilization Review and Clinical Denials & Appeals specialists. You will oversee staffing, coaching, and performance to ensure adherence to payer guidelines and SLAs.

Responsibilities include monitoring productivity and quality, auditing compliance, analyzing denial trends, and partnering with cross-functional teams to drive process improvements in utilization management and revenue cycle

Qualifications

Bachelor of Science in Nursing with active licensure (PHRN or USRN).
At least 1 year of supervisory experience in Utilization Management or Clinical Denials & Appeals.
3–5 years of acute care clinical experience (Med/Surg; ICU if applicable).
Proficiency with InterQual or MCG guidelines; strong knowledge of US healthcare regulations and revenue cycle processes.
Experience with hospital EMR systems (Epic, Cerner, Meditech).
Good command of English (CEFR B2) and strong communication skills.
Proven leadership, coaching, and ability to manage multiple priorities.

Responsibilities

Lead and supervise a team of Utilization Review and Denials & Appeals specialists.
Monitor productivity, quality, turnaround time, and SLAs; address performance gaps.
Oversee review and resolution of utilization management and denials; handle escalations.
Conduct audits to ensure payer compliance and documentation standards.
Analyze denial trends and collaborate across Billing, Coding, HIM, and Revenue Integrity.
Develop and present KPI dashboards and reports to leadership.
Collaborate with IT and cross-functional teams to optimize EMR and denials systems.
Mentor staff on utilization management and regulatory updates.