Health Clinical Services Senior Manager

Bravissimo Resourcing Inc.; Taguig; On-site; PHP 1,674,000 - 2,344,000; Full time

Benefits offered by this job

Performance Bonus

Incentives

13th Month Pay

Health Maintenance Organization (HMO)

Pag-IBIG Fund

Paid Holidays

Job summary

A staffing agency is seeking a qualified candidate for a supervisory position based in Taguig, with a focus on overseeing staff and ensuring compliance within the healthcare sector. Ideal candidates will possess at least 12 years of relevant experience, hold a valid US Registered Nurse license, and be familiar with BPO environments. The position offers a night shift schedule and comes with competitive benefits including performance bonuses and government-mandated benefits.

Qualifications

• At least 12 years of relevant experience and 10 years of supervisory.</li>
• Current and unrestricted US Registered Nurse license.
• BPO experience in any account preferred.
• BPO experience preferred but not required.
• 12+ years of relevant experience with 10+ years in supervision.

Responsibilities

• Oversees staff and ensures compliance with medical policy and member eligibility.
• Conducts treatment setting reviews.
• Handles service requests via inbound calls and facsimile.
• Completes review of post-service claims for Medical Necessity or Contractual Reviews.
• Ensures reviews align with member benefit contracts and health plan guidelines.

Skills

Supervisory Experience

US Registered Nurse License

BPO Experience

Healthcare Knowledge

Education

Bachelor's Degree

Job description

On-site - Taguig >10 Yrs Exp Bachelor Full-time

Job Description

Employee Recognition and Rewards

Performance Bonus, Incentives

Government Mandated Benefits

13th Month Pay, Pag-Ibig Fund, Paid Holidays

Insurance Health & Wellness

HMO

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 be 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.

OTHERS:

Shift Schedule: Night Shift

Skill and Qualifications:

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

Working Location

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• withholds your ID,
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• or other illegal situations.