Utilization Management Review Manager

1 week 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

  • USRN - Utilization Review

    3 days ago

    Taguig, National Capital Region, Philippines UST Full time ₱900,000 - ₱1,200,000 per year

    UST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. Our BPaaS solutions manage complex admin tasks, allowing our customers to prioritize members' well-being. With our commitment to simplicity, honesty, and leadership, we navigate challenges with our customers to achieve affordable health care...

  • Utilization management US RN Sr Analyst

    1 day ago

    Taguig, National Capital Region, Philippines Kels global ventures Full time ₱480,000 - ₱840,000 per year

    JOB TITLE: Utilization Management US RN Sr AnalystWORK SET UP: Full On-site in Uptown BGC, TaguigWORK SHIFT: Depends with the client and project but they are looking for someone who can work on a shifting schedule(Salary is confidential but sharing a range here for sourcing purposes only and never share to your candidates, only give them a hint that once...

  • HR Manager

    3 days ago

    Taguig, National Capital Region, Philippines weSource Management Consultancy Firm Full time ₱1,500,000 - ₱3,000,000 per year

    Role: HR ManagerLocation: Taguig (Hybrid with very rare work on site)Salary: 70K PackageShift: Mid ManilaKey Responsibilities:Strategic Leadership Support:Collaborate with senior leadership to understand business goals and translate them into HR strategies and initiatives.Provide guidance and support on organizational effectiveness, workforce planning, and...

  • PHRN - Utilization Nurse

    1 week ago

    Taguig, National Capital Region, Philippines AUMTREND PH INC Full time ₱900,000 - ₱1,200,000 per year

    Key ResponsibilitiesReview patient records and provider notes to validate clinical necessityComplete prior authorization forms and submit to payers via online portals or faxFollow up on status of submitted requests and escalate delays appropriatelyMaintain documentation accuracy and compliance with turnaround time requirementsBalance quality of care with...

  • USRN Utilization Nurse

    2 weeks ago

    Taguig, National Capital Region, Philippines AUMTREND PH INC Full time ₱900,000 - ₱1,200,000 per year

    Key ResponsibilitiesReview patient records and provider notes to validate clinical necessityComplete prior authorization forms and submit to payers via online portals or faxFollow up on status of submitted requests and escalate delays appropriatelyMaintain documentation accuracy and compliance with turnaround time requirementsRequirementsActive USRN...

  • Integrated Project Manager

    3 days ago

    Taguig, National Capital Region, Philippines weSource Management Consultancy Firm Full time ₱40,000 - ₱80,000 per year

    ROLE: Integrated Project ManagerSALARY: Up to 80KSET-UP: Hybrid (3 days onsite, 2 days remote)As part of the Client Services Department, you play a central role in the business and are pivotal to the smooth running of your account(s).You will be client focused that require good communication, organisation and time management skills to manage both your...

  • Senior Print Project Manager

    3 days ago

    Taguig, National Capital Region, Philippines weSource Management Consultancy Firm Full time ₱1,500,000 - ₱3,000,000 per year

    We are looking for a Senior Print Project Manager for our Creative agency client in BGC, Taguig.Salary: up to 75kSet-up: HybridSchedule: Mon-FriShift: Dayshift, MidshiftThe Role:Responsible for the coordination, adaptation, and implementation of the production process from brief through to the final production phases. Supporting Team Leaders and Project...

  • Project Manager

    1 week ago

    Taguig, National Capital Region, Philippines Ayuda Business Management Solutions Inc. Full time ₱900,000 per year

    Non Negotiable: Project Management Tools7 years of Project Management, Supply Chain, Warehouse Maintenance, Transportation and Logistics, and Industrial Engineering,Excellent Communication SkillsJob Qualifications:-In-depth understanding of Project Management and Industrial Engineering principles.-Proficiency in Project Management / Industrial Engineering...

  • Credit Review Officer

    3 days ago

    Taguig, National Capital Region, Philippines EastWest Bank Full time ₱900,000 - ₱1,200,000 per year

    About the JobLocation: BGC, TaguigCorporate Title: JO-SMWork Arrangement: OnsiteOur Credit Management team is looking for experienced professionals to join us in Taguig with the role of Credit Review OfficerLead a robust monitoring initiative for the Bank's Corporate Banking portfolio through thorough reviews and stress tests. Implement an Early Problem...

  • HR Manager

    3 days ago

    Taguig, National Capital Region, Philippines Ayuda Business Management Solution Inc. Full time ₱1,200,000 - ₱2,400,000 per year

    Job description:We are seeking an experienced and strategic HR Director to lead our human resources operations across both brands. This role is crucial in shaping our company culture, ensuring compliance, and driving talent management initiatives that align with our vision for excellence.Key Responsibilities:HR Strategy & LeadershipDevelop and implement HR...