Utilization Review Nurse - Appeals & Denials (Night Shift)

MicroSourcing; Taguig; On-site; PHP 446,000 - 781,000; Full time

Benefits offered by this job

Healthcare coverage from day one

Dependent coverage

Paid time off with cash conversion

Group life insurance

Performance bonuses

Flexible work arrangements

Career growth opportunities

Inclusive team culture

Job summary

MicroSourcing is hiring an Utilization Review Nurse in Taguig for onsite night shift. The role centers on reviewing denied claims, managing the appeals process, and ensuring timely submissions in line with payer policies.

Strong clinical, communication, and regulatory knowledge are essential. The ideal candidate has 3–5 years acute care experience, RN licensure, and familiarity with InterQual/MCG guidelines, plus EMR proficiency in Epic/Cerner/Meditech.

Qualifications

• Clinical Appeals Experience: At least 1 year of clinical appeal writing experience.
• Clinical Experience: 3–5 years acute care clinical experience in a hospital setting; 2–3 years ICU preferred.
• Education: Bachelor of Science in Nursing.
• Licensure: Registered Nurse with active PHRN or USRN license.
• RCM Knowledge: Proficiency with InterQual/MCG guidelines; knowledge of US government programs & insurance regs.
• Software Knowledge: EMR experience with Epic/Cerner/Meditech.

Responsibilities

• Work denials and appeals timely; evaluate denial reasons and payor policies.
• Submit retro-authorizations per payor requirements.
• Conduct medical necessity reviews and prepare clinical documentation summaries for appeals.
• Write and submit timely, compelling appeals with supporting docs.
• Document actions and follow up with payers and internal teams.
• Track status of denials and appeals and escalate as needed.
• Research best practices to improve the appeals process.
• Communicate professionally with payers and internal departments.

Skills

Clinical appeals

Acute care experience

RN licensure

RCM knowledge

EMR proficiency

English communication

Education

Bachelor’s degree in Nursing

Master’s degree (preferred)

Tools

Epic EMR

Cerner EMR

Meditech EMR

Job description

MicroSourcing is hiring an Utilization Review Nurse in Taguig for onsite night shift. The role centers on reviewing denied claims, managing the appeals process, and ensuring timely submissions in line with payer policies.

Strong clinical, communication, and regulatory knowledge are essential. The ideal candidate has 3–5 years acute care experience, RN licensure, and familiarity with InterQual/MCG guidelines, plus EMR proficiency in Epic/Cerner/Meditech.