PHRN Care Management Associate Cebu

Omega Healthcare Management Services, Inc.; Pasig; On-site; PHP 420,000 - 640,000; Full time

Benefits offered by this job

Performance Bonus

Incentives

HMO

Professional Development

Maternity Leave

Paternity Leave

Sick Leave

Job summary

A healthcare management provider in Pasig is seeking a Team Lead with a Bachelor's in Nursing and US healthcare experience. You will prioritize authorization requests, review patient documentation, and lead a team to ensure compliance with company policies. The ideal candidate will have strong leadership, planning skills, and a proven background in process management. This full-time role offers a supportive work environment with opportunities for professional development and performance bonuses.

Qualifications

• Active PH registered nurse license required.
• Minimum 2 years of Team Lead experience in a US Healthcare account.
• Strong leadership and interpersonal relationship skills.
• Ability to manage processes and adapt to changing requirements.

Responsibilities

• Prioritize authorization requests according to urgency.
• Review patient’s clinical documentation.
• Perform outbound calls to payer's authorization department.
• Communicate process changes to team members.
• Monitor activities of nurses for compliance.
• Coordinate with nurses to monitor schedule adherence and productivity.
• Provide basic on-the-job training and act as resource for policies.

Skills

Leadership

Interpersonal relationship

Process Management

Planning

Process improvement

Education

Bachelor of Science in Nursing

Job description

On-site - Pasig 1-3 Yrs Exp Bachelor Full-time

Job Description

Employee Recognition and Rewards

Performance Bonus, Incentives

Government Mandated Benefits

Insurance Health & Wellness

HMO

Professional Development

Professional Development

Maternity & Paternity Leave, Sick Leave

Responsibilities

• Prioritize incoming authorization and referral requests according to queue urgency
• Review patient’s clinical and chart documentation related to the service submitted by the provider’s office
• Obtain and/or follow up on authorization and referral requests from the patient’s payer/s through any of the following methods—depending on the payer’s policy:
• Perform outbound calls to payer’s authorization department
• Access payer’s authorization online portal
• Submit faxes to payer’s authorization department
• Respond to payer’s clinical questions to be able to proceed with the authorization and referral requests
• Obtain and/or follow up payer’s peer‑to‑peer review requirements and send them back to provider’s office for the actual initiation
• Cater inbound calls from payers and perform necessary actions required for the task
• Listen and review voicemail messages from payers then perform necessary actions required for the task
• Monitor activities of nurses to assess schedule adherence, accuracy, quality, productivity, timeliness and compliance with job requirements, policies and procedures. Report updates to management.
• Provide basic on‑the‑job training for direct reports and serve as a resource to address questions related to the policies, processes and procedures.
• Monitor, identify and resolve performance/behavior/attendance issues using prescribed performance management techniques.
• Adhere to all company policies and procedures.
• Adjust to the needs of meeting service level agreements under supervision of manager.
• Ensure training needs of team members are met.
• Successfully complete all client‑related training and keep record of the same.
• Hold team briefings on a daily basis with the team.
• Communicate all process and client changes to direct reports within specific timelines and keep record of such updates.
• Act as a single point of contact for the assigned team members for all their job‑related needs and create a harmonious work environment.
• Escalate performance‑related issues with respect to assigned team members to managers on a timely manner (PIP).
• Responsible for day‑to‑day functional supervision of work group, including work assignment and attendance monitoring; providing input into selecting, training, developing, and completing performance appraisal of work group(s) in accordance with the organization’s policies and applicable compliance requirements.
• Employee separations to be handled in‑line with company policies and HR

Required Experience

• Graduate of Bachelor of Science in Nursing with active PH registered nurse license
• Minimum 2 years of Team Lead experience in a US Healthcare account (Prior Authorization or Claims/Denial/Appeal)
• Excellent Leadership & Interpersonal relationship
• Strong Process Management & planning skills
• Embrace change and think operationally to achieve business goals
• Proven process improvement experience