- Supervise and mentor a team of PHRN Utilization Review Nurses.
- Monitor team productivity, quality, and compliance with client and regulatory guidelines
- Assist in conducting pre-service, concurrent, and post-service medical necessity reviews as needed.
- Ensure accurate and timely completion of utilization reviews using MCG, InterQual, or client-specific criteria.
- Serve as the first point of escalation for clinical and operational issues.
- Coordinate daily workflow, assign tasks, and ensure adequate staffing coverage.
- Review audit findings and coach team members for continuous improvement.
- Participate in onboarding, training, and upskilling of new hires and existing team members.
- Collaborate with the Operations Manager and Clinical Director for reporting and strategic planning.
- Active Philippine Registered Nurse (PHRN) license
- At least 3 years of clinical experience in a hospital or acute care setting
- Minimum of 2 years experience in Healthcare BPO (UMR,CD, Prior Auth, Denials and appeals, etc.)
- At least 2 years in a supervisory or leadership role within a BPO or healthcare setting
- Proficient in using EMR and utilization review platforms
- Strong communication, problem-solving, and decision-making skills
- Willing and able to work night shifts to support U.S. operations
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PHRN Team Lead - Taguig - Access Healthcare
Paglalarawan
We are looking for a PHRN Team Lead to oversee and support a team of Utilization Review Nurses in providing high-quality medical necessity reviews for our U.S. healthcare clients.
This leadership role requires strong clinical knowledge, hands-on UR experience, and the ability to guide and motivate a team in a fast-paced, remote work environment.
Key Responsibilities:
Qualifications:
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