Healthcare Utilization Manager

6 days ago


Sorsogon, Bicol, Philippines beBeeUtilization Full time ₱55,000 - ₱155,000

As a Utilization Management Specialist, you will be responsible for assessing and interpreting customer needs, requirements, and medical records to ensure optimal outcomes.

Job Summary:

The role involves reviewing medical claims for medical necessity, evaluating data, and making informed decisions to meet business objectives.

Key Responsibilities:

  • Assess customer needs, interpret medical records, and make recommendations
  • Review medical claims to determine medical necessity
  • Ensure compliance with laws, regulations, and company policies
  • Develop strategies to improve utilization management processes

Requirements:

  • Active PHRN and USRN Mainland License
  • At least 1 year of bedside experience, preferably with UR/UM experience
  • Excellent analytical, communication, and problem-solving skills

Working Conditions:

Work from home environment providing flexibility and autonomy.

Additional Information:

The ideal candidate will possess excellent critical thinking and problem-solving skills, with the ability to work independently and as part of a team. If you are a detail-oriented individual with strong analytical skills and a passion for healthcare, we encourage you to apply.



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