Utilization & Denials Management Manager

Discover your 100% YOU with MicroSourcing
Position:
Utilization & Denials Management Manager

Location:
Taguig

Work setup & shift:
Onsite | Night shift

Why join MicroSourcing?
You'll Have

• Competitive Rewards: Enjoy above-market compensation, healthcare coverage on day one, 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 & Denials Management Manager, You Will
Operational Oversight

• Manage a team to achieve goals by overseeing daily activities, assigning tasks, and providing guidance and motivation.
• Set objectives, monitor performance, solve problems, and facilitate communication between the team and upper management.
• Provide strong leadership, communication, and problem-solving support to ensure operational efficiency.

Quality & Compliance

• Address Utilization Management and Clinical Denials, partnering with Billing and A/R teams to identify root causes.
• Stay current on Utilization Management and Clinical Denials updates and disseminate guidance to staff.
• Ensure policies and procedures reflect current compliant practices for medical coding and denials/appeals management.

Collaboration & Support

• Communicate team performance in Operations Meetings, including reporting KPIs, progress, and opportunities.
• Collaborate with HIM, Revenue Integrity, Coding, Billing, and Clinical departments to ensure clean claim generation.
• Support coding accuracy through collaboration with revenue integrity teams.
• Coordinate with IT for optimization of encoder, EHR, Utilization Management, and Clinical Denials & Appeals systems.

Education & Training

• Provide guidance on education strategies for Utilization Management and Clinical Denials & Appeals, including updates on clinical denials, documentation changes, and audit findings.
• Mentor supervisors, trainers/QA specialists, and RN specialists to support succession planning and career development.

Coordinating with Healthcare Providers

• Work closely with physicians, nurses, and other healthcare professionals to ensure timely and accurate documentation reflecting patient care.
• Perform other duties and responsibilities as assigned.

What You Need
Non-negotiables

• At least 2 years of experience managing Utilization Management and/or Clinical Denials & Appeals teams.
• 3–5 years of acute care clinical experience in a hospital setting (Med/Surg or similar); 2–3 years if ICU background.
• Bachelor of Science in Nursing.
• Active Registered Nurse (RN) license with PHRN or USRN credentials.
• Proficiency in InterQual or MCG clinical guidelines with strong knowledge of U.S. Government Programs and Insurance Regulations.
• Experience with hospital-based EMR systems such as Epic, Cerner, or Meditech.
• Strong verbal and written English communication skills (CEFR B2 minimum) and customer service skills.

Preferred skills/expertise

• Master's degree or credential in business, healthcare, or a related field preferred.
• Certification in case management, clinical appeals, or clinical denials (ACMA preferred).
• Proficiency in tracking tools for authorizations, denials, and appeals, as well as Microsoft Office Suite (Excel, Word, PowerPoint, Outlook, SharePoint).
• Proven leadership experience managing teams, including coaching, mentoring, and performance management.
• Ability to independently lead teams, set project direction, develop deliverables, escalate risks, and influence stakeholders.
• Strong analytical and critical thinking skills with experience in a matrixed environment.
• Ability to pay close attention to detail with strong follow-up and follow-through skills.
• Demonstrated teamwork, integrity, and professionalism in all work-related activities.
• Excellent written and verbal communication skills, including ability to create impactful presentations.
• Comfortable making complex decisions independently using sound judgment and discretion.

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 foster an inclusive culture that embraces individuals of all races, genders, ethnicities, abilities, and backgrounds.

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%

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Terms & conditions apply.