USRN - Health Clinical Services Senior Manager

5 days ago

Taguig, National Capital Region, Philippines Cruz-Caymo Partners and Associates, CPAs Full time

JOB TITLE: Health Clinical Services Senior Manager - USRN

WORK SET UP: Onsite in Taguig

WORK SHIFT: Night shift

Rest Day: Weekends

Location: Taguig City

Salary budget: 150K - 250K

Responsibilities:

Oversees staff whose teams' primary duties may include, but are not limited to:

  • Conducts pre-service, concurrent, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
  • Service requests may be from inbound calls and facsimile.
  • Outbound calls to the provider may be required to gather additional information that may be needed.
  • Other staff responsibilities may include review and analysis of post-service claims utilizing the member's benefit contract and health plan guidelines.
  • Completes review of pended claims post-service for either Medical Necessity or Contractual Reviews.

SKILL AND QUALIFICATIONS:

  • At least 12 years of relevant experience and 10 years of supervisory experience
  • Holds current and unrestricted US Registered Nurse license. No state-specific RN licensure required.
  • BPO experience should be any account (Health account experience is only a plus, but not required)
  • Work Background/Experience in General: Must be open to BPO & Non-BPO Experience
  • Open for those applicants who are currently in Philippines and already have the right to live and work in this country

Job Types: Full-time, Permanent

Pay: Php150, Php250,000.00 per month

Benefits:

  • Additional leave
  • Company Christmas gift
  • Company events
  • Health insurance
  • Life insurance
  • Opportunities for promotion
  • Paid training
  • Pay raise

Application Question(s):

  • Do you have an active USRN License?
  • How much is your last drawn salary?
  • How much is your salary expectation?
  • Are you amenable to working onsite set up with a shifting schedule in Taguig?
  • Can start ASAP?
  • At least 12 years of relevant experience and 10 years of supervisory experience?

Work Location: In person

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