Phrn Team Leader

3 weeks ago

Metro Manila Philippines Buscojobs Full time

Overview

We are seeking an experienced Registered Nurse to serve as Team Leader for our Virtual Utilization Review Team. This leadership role involves supervising a team of UR nurses, ensuring clinical quality, compliance, and productivity, and acting as a liaison between clinical staff, clients, and internal stakeholders. The ideal candidate will have a strong background in utilization review and leadership within a healthcare BPO or managed care setting.

Key Responsibilities
  • Supervise and mentor a team of virtual utilization review nurses to ensure timely, accurate, and compliant case reviews.
  • Monitor team performance metrics, including productivity, quality assurance, and turnaround times.
  • Conduct regular team huddles, case discussions, and performance reviews to foster continuous improvement.
  • Review complex or escalated clinical cases and provide guidance or second-level decision support.
  • Ensure the team adheres to evidence-based guidelines (e.g., MCG, InterQual), payer policies, and regulatory standards.
  • Coordinate with clients and internal quality teams to address feedback, audits, or updates to clinical protocols.
  • Lead training and onboarding programs for new UR nurses.
  • Collaborate with operations and workforce management to ensure adequate staffing and coverage across shifts.
  • Prepare reports and presentations for management and client stakeholders.
Qualifications
  • Active PRC License
  • At least 1 year experience in acute hospital settings
  • At least 1 year of experience in utilization review, case management, or medical management in a BPO setup
  • At least 1 year of leadership experience in a healthcare BPO
  • Strong knowledge of medical terminology and utilization management guidelines (InterQual, MCG).
  • Strong knowledge in EPIC/CERNER
  • Proven ability to lead and inspire remote teams in a performance-driven environment.
  • Excellent communication, decision-making, and conflict-resolution skills.
  • Proficiency in EMR systems, UR platforms, and Microsoft Office Suite.
Work Set up
  • Work onsite at Pasay
  • Permanent night shift
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