JOB TITLE: Health Clinical Services Senior Manager - USRN

WORK SET UP: Onsite in Taguig

WORK SHIFT: Night shift

Rest Day: Weekends  

Location: Taguig Uptown Bonifacio Tower 3

Salary budget: 150K - 250K (Confidential)

Responsibilities:

Oversees staff whose teams’ primary duties may include, but are not limited to: 

• Conducts pre-service, concurrent, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.  

• Service requests may be from inbound calls and facsimile. 

• Outbound calls to the provider may be required to gather additional information that may be needed. 

• Other staff responsibilities may include review and analysis of post-service claims utilizing the member’s benefit contract and health plan guidelines. 

• Completes review of pended claims post-service for either Medical Necessity or Contractual Reviews.

SKILL AND QUALIFICATIONS:    

• At least 12 years of relevant experience and 10 years of supervisory experience

• Holds current and unrestricted US Registered Nurse license. No state-specific RN licensure required.

• BPO experience should be any account (Health account experience is only a plus, but not required)

• Work Background/Experience in General: Must be open to BPO & Non-BPO Experience

• Open for those applicants who are currently in Philippines and already have the right to live and work in this country  are eligible for this role

 

RECRUITMENT PROCESS:

• Endorse for validation

• Screening with CV Reviewer

• Endorse for CV screening through Workday, along with the HRI toolkit, FCV and CV

• For reviewing with the client

PRE-SCREENING QUESTIONS:

1. Do you have an active USRN license?

2.  How much is your last drawn salary?

3. How much is your salary expectation?

4. Are you amenable to working onsite set up with a shifting schedule in Taguig?