Utilization Management Supervisor | Onsite, Night shift

Hammerjack Pty Ltd; Taguig; On-site; PHP 900,000 - 1,200,000; Full time

Benefits offered by this job

Healthcare on Day 1 for employee and 1

Dependents coverage

Paid time off with cash conversion

Group life insurance

Performance bonuses

Team events and activities

Flexible work arrangements

Job summary

MicroSourcing in the Philippines is seeking an Utilization Management Supervisor to lead a team of reviewers and analysts onsite in Taguig. The role requires RN licensure, supervisory experience, and strong knowledge of US payer guidelines, with a focus on optimizing denials management and revenue cycle performance.

You’ll oversee audits, KPI reporting, and cross‑functional collaboration with IT and clinical teams, while fostering professional growth and operational excellence in a fast-paced

Qualifications

• BSN with an active PHRN or USRN license.
• At least 1 year in supervisory Utilization Management or Clinical Denials & Appeals.
• 3–5 years of acute care hospital experience (Med/Surg preferred; ICU if applicable).
• Proficient with InterQual or MCG guidelines and US healthcare regulations.
• Experience with EMR systems such as Epic, Cerner, or Meditech.
• Excellent English communication (CEFR B2).
• Strong leadership, coaching, analytical, and multi‑priority skills.

Responsibilities

• Lead and supervise a team of utilization review and denials specialists.
• Monitor productivity, quality, SLAs and coach performance.
• Oversee reviews of utilization management, denials and appeals per guidelines.
• Conduct audits to ensure payer and regulatory compliance.
• Analyze denial trends and drive process improvements with cross‑functional teams.
• Develop operational reports, KPI dashboards, and leadership updates.
• Collaborate with IT to optimize EMR and related systems.
• Mentor team on best practices, regulatory updates, and growth.

Skills

Leadership

Coaching

Analytical

Decision making

Project management

Communication

Education

BSN with active PHRN/USRN license

Tools

Epic

Cerner

Meditech

MS Office Suite

Job description

Utilization 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 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%!