Job Title: USRN/PHRN Team Leader 

Location: Quezon City (On-site)

Shift: Night Shift (aligning with US hours)

Salary: PHP 70,000 - 120,000 per month (dependent on experience and credentials)

Start Date: Immediate or as soon as possible

Recruitment Process: Two virtual interview stages

About the Role:

We are seeking an experienced and licensed USRN or PHRN to lead a dedicated healthcare team. In this pivotal role, you will apply your clinical expertise in utilization management, overseeing case reviews and ensuring compliance with InterQual criteria. The ideal candidate is a proven leader with strong clinical knowledge, excellent communication skills, and the ability to thrive in a fast-paced, detail-oriented environment.

Key Responsibilities:

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  Lead and supervise a team of clinical staff in utilization management activities.

  
  


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  Conduct medical necessity reviews using InterQual criteria.

  
  


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  Manage multiple cases while meeting strict regulatory turnaround times.

  
  


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  Ensure accurate and thorough case documentation.

  
  


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  Serve as a clinical resource and provide guidance on complex cases.

  
  


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  Collaborate effectively to maintain high standards of quality and compliance.

  
  

Qualifications:

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  Active and valid PHRN or USRN license.

  
  


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  Minimum of 2 years of acute care bedside experience in an ER or ICU setting.

  
  


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  Minimum of 1 year of hands-on experience applying InterQual criteria.

  
  


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  At least 1 year of experience in a Team Lead or Supervisor role within a healthcare, clinical, or related support environment.

  
  


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  Proven experience in utilization management with a US-based insurance company, hospital, or equivalent.

  
  


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  Excellent verbal and written English communication skills.

  
  


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  Strong proficiency in Microsoft Office (Word, Excel, Outlook).

  
  


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  Solid clinical knowledge, especially in medical necessity review and interpretation of clinical documentation.

  
  


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  Willingness to work on-site in Quezon City on a night shift schedule, including US holidays.

  
  

Preferred Qualifications:

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  Knowledge of healthcare insurance processes, appeals, grievances, and utilization management.