USRN – Health Clinical Services Senior Manager
1 week ago
USRN – Health Clinical Services Senior Manager
Location: Taguig City (Onsite, Uptown Bonifacio Tower 3)
Shift: Night Shift | Weekends Off
Hiring Level: Senior Leadership
Salary Range:
About the Role
We are hiring an experienced US Registered Nurse (USRN) to lead clinical review and utilization management teams within a healthcare services environment. This is a senior leadership role responsible for overseeing medical necessity reviews, claims analysis, and clinical compliance activities while ensuring service excellence and regulatory adherence.
This position is ideal for seasoned clinical leaders with strong utilization review, people management, and healthcare operations experience.
Key Responsibilities
Lead and oversee clinical teams performing:
Pre service, concurrent, retrospective, and out of network reviews
Medical necessity and appropriateness of care evaluations
Post service claims and contractual reviews
Ensure compliance with medical policies, member benefits, and health plan guidelines
Manage inbound and outbound clinical communications with providers
Review pended claims for medical necessity and contractual accuracy
Drive quality, productivity, and compliance across teams
Provide leadership, coaching, and performance management to supervisory staff
Qualifications
Active and unrestricted USRN license (any state)
At least 12 years of relevant experience, including 10 years in a supervisory/leadership role
Experience in Utilization Review, Clinical Review, or Health Services Management
Work Setup
Onsite role based in Taguig City
Night shift schedule
Weekend rest days
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