Operations Manager for Utilization Management

18 hours ago

Manila, National Capital Region, Philippines Recruitiere Sie Full time

Job Title: Operations Manager for Utilization Management

Shift: Night shift

Location : On-site

Salary Range: 150K to 180K

Start Date: ASAP

Job Summary:

The Operations Manager for Utilization Management is responsible for managing and overseeing operations while ensuring compliance with industry standards and regulatory requirements. This role involves collaborating with various stakeholders to drive performance and maintain high-quality standards.

Qualifications:

  • Bachelor's Degree in Nursing with an active and valid nursing license.
  • Minimum of 1-2 years in a managerial role overseeing team leaders or supervisors.
  • Experience managing teams in Utilization Management and clinical denials.
  • Experience with appeals denials, utilization review, or related healthcare management functions.
  • Familiarity with Medical Guidelines (e.g., MCG, InterQual, NCQA, ODG).
  • Excellent verbal and written communication skills.
  • Willingness to work on-site with flexible schedules, including night shifts and holidays.

Key Responsibilities:

  • Oversee daily operations and ensure compliance with service level agreements (SLAs) and regulatory standards.
  • Develop and implement process improvement initiatives.
  • Manage team performance and resource allocation.
  • Collaborate with internal stakeholders to enhance service delivery and maintain accurate staffing levels.
  • Ensure adherence to HIPAA and other regulatory requirements.

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