PHRN Team Leader

2 days ago

Pasay, National Capital Region, Philippines Access Healthcare Services Manila, Inc. Full time ₱900,000 - ₱1,200,000 per year

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 BPO set up
  • At least 1 year of leadership experience in a healthcare BPO
  • Strong knowledge of medical terminology and utilization management guidelines (InterQual, MCG).
  • Strong knowledgeable 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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