USRN- Health Clinical Senior Manager

Gratitude Philippines; Taguig; On-site; PHP 1,500,000 - 2,500,000; Full time

Job summary

A healthcare services provider is seeking an experienced Health Clinical Services Senior Manager for their Taguig location. The role involves overseeing clinical staff and conducting compliance reviews in a fast-paced environment. Ideal candidates should have at least 12 years of relevant experience, 10 of which should be in supervisory roles, and a current US Registered Nurse license. BPO experience is advantageous. This on-site position will require night shifts, and weekends are designated as rest days.

Qualifications

• Minimum 12 years of relevant experience including 10 years in supervisory roles.
• Must hold current US Registered Nurse license with no state-specific requirements.
• BPO experience is preferred but not mandatory.
• 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.
• Should not be a job hopper who only works for less than a year per company.

Responsibilities

• Oversee staff in various clinical service duties.
• Conduct compliance reviews related to treatment settings and member eligibility.
• Manage and analyze post-service claims.
• 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.

Skills

At least 12 years of relevant experience

10 years of supervisory experience

Current and unrestricted US Registered Nurse license

BPO experience

Work Background in General

Job description

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: Depends on Experience

Ready to join Accenture’s team of empowered people? We’re looking for candidates with the following skills and experience for this role. Do you fit the profile? If you do, we’d love to hear from you! In adherence to Accenture’s process of Identity Verification, your resume or CV must include your photo to ensure the accuracy of your application.

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
• Should not be a job hopper who only works for less than a year per company

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