Assistant Manager-Utilization Management Projects

4 weeks ago

Makati, Philippines Maxicare Healthcare Corporation Full time

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  • 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 the 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.
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 the 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.
Experience And Training
  • At least 3–5 years of experience in utilization management, healthcare operations, or project management.
  • Strong analytical skills with experience in data-driven decision-making.
  • Proficiency in project management tools (e.g., Asana, Trello, Jira) and data visualization platforms (Power BI, Google Sheets).
  • Excellent communication and stakeholder management skills.
  • Ability to work across teams and manage multiple operational projects simultaneously.
  • Knowledge of healthcare utilization, claims processes, and provider negotiations is an advantage.
Seniority level
  • Seniority level Mid-Senior level
Employment type
  • Employment type Full-time
Job function
  • Job function Project Management and Information Technology
  • Industries Hospitals and Health Care

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