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:

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

• Conduct medical necessity reviews using InterQual criteria.

• Manage multiple cases while meeting strict regulatory turnaround times.

• Ensure accurate and thorough case documentation.

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

• Collaborate effectively to maintain high standards of quality and compliance.

Qualifications:

• Active and valid PHRN or USRN license.

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

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

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

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

• Excellent verbal and written English communication skills.

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

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

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

Preferred Qualifications:

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