Healthcare Utilization Manager

2 days ago

Makati City, National Capital Region, Philippines beBeeUtilization Full time ₱800,000 - ₱1,200,000
Job Description

This role focuses on leading the implementation of initiatives aimed at enhancing UM operations, including provider redirection, cost control, and process automation.

  • The ideal candidate will oversee projects aligned with company goals for medical utilization cost containment.
Data Analysis & Performance Tracking

We are seeking an individual to analyze medical utilization patterns, claims data, provider performance, and programs performance to identify areas for improvement.

  • The selected candidate will work with different stakeholders to develop dashboards, reports, and insights that support UM strategies.
  • They will monitor and track key metrics such as LOA issuance rates, outlier detection trends, and cost savings achieved.
Stakeholder Coordination

Candidates should be able to collaborate with other teams to execute projects and align strategies.

  • Regular updates on operational performance and project outcomes will be provided to management.
Policy Execution & Compliance

We require a skilled professional to implement UM policies related to utilization cost management and ensure adherence across operational workflows.

  • The selected candidate will assist in the formulation and execution of policy changes to enhance cost efficiency without compromising care quality.
  • They will ensure compliance with regulatory requirements and internal guidelines.
Risk Management & Quality Assurance

The ideal candidate will monitor patient outcomes to ensure that cost-control measures do not negatively impact healthcare quality.

  • They will identify and mitigate risks associated with high-cost cases and chronic disease management.
  • The selected candidate will support UM leadership in implementing corrective actions when utilization patterns indicate potential inefficiencies or risks.

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