Assistant Manager-Utilization Management
4 weeks ago
Join to apply for the Assistant Manager-Utilization Management role at Maxicare Healthcare Corporation .
Responsibilities- Oversee and implement initiatives aimed at improving UM operations, including but not exclusive to provider redirection, cost control, and process automation.
- Identify inefficiencies in UM workflows and propose data-driven and process improvements.
- Support the rollout of various UM programs and initiatives.
- Ensure that operational projects align with company goals for medical utilization cost containment.
- Analyze medical utilization patterns, claims data, provider performance and programs performance and identify cost drivers and areas for improvement.
- Work with different key stakeholders to identify requirements such as development of dashboards, reports, and insights that support UM strategies.
- Monitor and track key metrics such as LOA issuance rates, outlier detection trends, and cost savings achieved.
- Collaborate with other UM, Medical, PNM, and Operations teams to execute projects and align strategies.
- Provide regular updates to management on operational performance and project outcomes.
- Implement UM policies related to utilization cost management and ensure adherence across operational workflows.
- Assist in the formulation and execution of policy changes to enhance cost efficiency without compromising care quality.
- Ensure compliance with regulatory requirements and internal guidelines.
- Monitor patient outcomes to ensure that cost-control measures do not negatively impact healthcare quality.
- Identify and mitigate risks associated with high-cost cases and chronic disease management.
- Support UM leadership in implementing corrective actions when utilization patterns indicate potential inefficiencies or risks.
- Mid-Senior level
- Full-time
- Health Care Provider
- Hospitals and Health Care
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Makati, Philippines Maxicare Healthcare Corporation Full timeJoin to apply for the Assistant Manager-Utilization Management Projects role at Maxicare Healthcare Corporation 1 month ago Be among the first 25 applicants Join to apply for the Assistant Manager-Utilization Management Projects role at Maxicare Healthcare Corporation Oversee and implement initiatives aimed at improving UM operations, including but not...
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