USRN- Health Clinical Senior Manager

Recruitify_HR; Taguig; On-site; PHP 2,000,000 - 3,000,000; Full time

Job summary

A leading healthcare recruitment agency is looking for a Health Clinical Services Senior Manager in Taguig. The ideal candidate will have over 12 years of relevant experience, including 10 years in supervisory roles, and must hold a current US RN license. This role involves overseeing team compliance with health standards, conducting treatment reviews, and managing service requests. Candidates must already reside in the Philippines and have the right to work. This position is onsite with a night shift schedule.

Qualifications

• Minimum 12 years of relevant experience with 10 years in supervisory roles.
• Current unrestricted US Registered Nurse license required.
• Must be eligible to live and work in the Philippines.
• Willing to work onsite in Taguig, Philippines.
• Experience in BPO/healthcare accounts preferred.

Responsibilities

• Oversee staff performance in compliance reviews.
• Conduct treatment setting reviews for appropriateness.
• Facilitate inbound and outbound communication for service requests.
• Analyze post-service claims for medical necessity.
• Completes review of pended claims post-service for medical necessity or contractual reviews.

Skills

Supervisory experience

US RN license

BPO experience

General work background

Education

US RN license

Job description

Job Title

Health Clinical Services Senior Manager - USRN

Work Setup

Onsite in Taguig

Work Shift

Night shift

Rest Day

Weekends

Location

Taguig Uptown Bonifacio Tower 3

Salary

Depends on Experience

Ready to join Accentures team of empowered people? We are 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 Accentures 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 members 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