Utilization Management Review Manager

2 days ago

Taguig, National Capital Region, Philippines Access Healthcare Services Manila, Inc. Full time ₱1,500,000 - ₱2,500,000 per year

We are seeking an experienced Medical Allied Graduate Manager to lead and manage the operational delivery of our UM/UR services for U.S.-based healthcare clients

This strategic role is responsible for driving service quality, team performance, client satisfaction, and operational excellence across multiple Utilization Review accounts

Key Responsibilities:

  • Provide end-to-end management of UMR delivery operations, including staffing, quality, SLAs, productivity, and client satisfaction.
  • Lead and mentor Team Leads and Supervisors across multiple accounts.
  • Collaborate with clients to ensure alignment of clinical review workflows with business expectations.
  • Monitor and drive performance metrics such as TAT, accuracy, utilization trends, and compliance with URAC/NCQA guidelines.
  • Oversee implementation of new processes, service transitions, and process improvements.
  • Serve as point of escalation for operational, clinical, or quality-related concerns.
  • Conduct regular business reviews with internal leadership and clients.
  • Ensure compliance with HIPAA and U.S. healthcare regulations.
  • Coordinate with cross-functional departments such as QA, Training, Workforce, and Recruitment to support business needs.

Required Qualifications:

  • Must be graduate of Medical Allied Course
  • PHRN license is preferred but not required
  • At least 3 years total experience in healthcare delivery or clinical operations
  • At least 2 years' experience in a Utilization Management/Review role
  • 2 years in a leadership role, preferably as Operations Manager, Team Lead, or Service Delivery Manager
  • Strong knowledge of MCG/InterQual guidelines, ICD-10, CPT coding, and U.S. payer systems
  • Excellent communication, client management, and team leadership skills
  • Strong data analysis, reporting, and strategic planning abilities
  • Willing to work in a night shift schedule

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