Clinical Services Manager

2 days ago

Taguig, National Capital Region, Philippines HRTX Full time $100,000 - $120,000 per year


Qualifications:

Experience & Education

  • Minimum of 5+ years of combined experience in direct patient care and/or a clinical administrator role (e.g., utilization management, clinical authorizations, clinical denials, or clinical documentation integrity) with a solid track record in reputable organizations.
  • Registered Nurse (RN) or hold another clinical patient care designation.
  • BS/BA required; a graduate degree in health, medicine, or nursing is preferred.
  • Exposure to U.S. revenue cycle processes is a strong plus.

Industry Knowledge

  • Comprehensive understanding of the U.S. healthcare industry, including both payor and provider ecosystems and their interrelationships.
  • Familiarity with clinical RCM vendors, services, trends, market disruptions, and key differentiators.

Technical Expertise

  • Hands-on experience with revenue cycle-related technology within the clinical revenue cycle, such as computer-assisted CDI, auditing, utilization management review, and clinical appeal automation.

Global Perspective

  • Preferred: At least 2+ years of experience working in or with global RCM business process outsourcing (BPO) delivery models.

Continuous Learning

  • Strong ability to learn and synthesize new information quickly.
  • Demonstrates intellectual curiosity and stays current on industry trends to help shape solution frameworks and intellectual property for the service line.

Jobs-to-Be-Done

  1. Serve as Clinical Subject Matter Expert (SME)
    • Strategic Support: Collaborate with the VP of Coding and Clinical Service Line to drive operational excellence and execute the organizations strategy for relevant service lines.
    • Go-to-Market Support: Communicate effectively internally and externally with strong clinical domain expertise. Contribute to thought leadership by researching and developing market-facing content such as white papers, case studies, marketing collateral, clinical website sections, and webinar materials. Ensure all content reflects current industry-leading practices and delivery models.
    • Clinical Analytics: Identify and collect key performance indicators (KPIs) for clinical service lines. Analyze project data to generate insights on production, quality, and outcomes for internal performance tracking and external reporting.
    • Education & Training: Partner with the Director of Clinical Education to design and update clinical training programs. Work collaboratively with internal teams (Talent Development, Operations, etc.) to ensure a comprehensive training approach that reflects industry trends and regulatory requirements.
  2. Support Strategic Development
    • Assist in refining, developing, and implementing the companys Clinical Solutions strategy in alignment with the organizations long-term (5+ year) strategic goals.
  3. Drive Clinical Initiatives
    • Provide support for other clinical service line initiatives as assigned, contributing to continuous improvement and innovation.

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