Manager Medical Management
7 days ago
Position Title:
Manager Medical ManagementShift:
Job Description:
Responsible to manage a team of clinicians charged with promoting quality member outcomes, to optimize member benefits, and to promote effective use of resources. Primary duties may include, but are not limited to: Ensures adherence to medical policy and member benefits in providing service that is medically appropriate, high quality, and cost effective. Areas managed may include authorizing inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources. Applies clinical knowledge to work with facilities and providers for care-coordination. May also manage appeals for services denied. Hires, trains, coaches, counsels, and evaluates performance of direct reports. Requires current active unrestricted RN license to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States, except in government business where it is preferred, and 5 years acute care clinical experience or any combination of education and experience, which would provide an equivalent background. Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. The following are level distinctions not required for posting. This level typically reflects a new manager, one managing a singular function, a manager with a smaller span of management, or one located in a unit where a higher level of management exists.For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
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Nurse Medical Management
7 days ago
PHL-Taguig City-Alliance Global Tower, th Ave, Corner th St, Uptown Bonifacio, Philippines Carelon Global Solutions Full time ₱60,000 - ₱120,000 per yearPosition Title:Nurse Medical Management (USRN)Shift:Job Description:Responsible for collaborating with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources.Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient...
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Nurse Medical Mgmt I
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PHL-Taguig City-Alliance Global Tower, th Ave, Corner th St, Uptown Bonifacio, Philippines Carelon Global Solutions Full time $45,000 - $70,000 per yearPosition Title:Nurse Medical Mgmt IShift:Job Description:Responsible for collaborating with healthcare providers and or members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources for more complex medical issues. Ensures medically appropriate, high quality, cost effective care through assessing the...
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Nurse Medical Mgmt I
7 days ago
PHL-Taguig City-Alliance Global Tower, th Ave, Corner th St, Uptown Bonifacio, Philippines Carelon Global Solutions Full time $10,000 - $18,000 per yearPosition Title:Nurse Medical Mgmt I (PHL)Shift:Job Description:Responsible for collaborating with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources. Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient...
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USRN Assistant Manager
7 days ago
PHL-Taguig City-Alliance Global Tower, th Ave, Corner th St, Uptown Bonifacio, Philippines Carelon Global Solutions Full time ₱90,000 - ₱108,000 per yearPosition Title:USRN Assistant Manager - For Internal HiringShift:Job Description:Responsible for serving as the operations point of contact for Medical Management day to day operations, including but not limited to, facilitating issue resolution, meeting goals and targets.Primary duties may include, but are not limited to:Acts as a liaison for both internal...
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Payroll Manager
7 days ago
PHL-Taguig City-Alliance Global Tower, th Ave, Corner th St, Uptown Bonifacio, Philippines Carelon Global Solutions Full time ₱1,200,000 - ₱1,500,000 per yearPosition Title:Payroll ManagerShift:Job Description:The Payroll Manager shall be responsible for ensuring that the payroll & time keeping functions are operating effectively. Primary duties may include, but are not limited to:Managing & ensuring the efficient operation of the payroll function & department, including the generation, payout & reporting of...
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Phrn - 2024
7 days ago
PHL-Taguig City-Alliance Global Tower, th Ave, Corner th St, Uptown Bonifacio, Philippines Carelon Global Solutions Full time ₱300,000 - ₱500,000 per yearPosition Title:PHRN - 2024Shift:Job Description:Responsible for providing non-clinical support to the Medical Management and/or Operations areas.Primary duties may include, but are not limited to:Gathers clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med...
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DRG Clinical Validation Auditor
5 days ago
PHL-Taguig City-Alliance Global Tower, th Ave, Corner th St, Uptown Bonifacio, Philippines Carelon Global Solutions Full time $420,000 - $840,000 per yearPosition Title:DRG Clinical Validation Auditor - ManilaShift:Job Description:"Responsible for auditing inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims.• Primary duties may include but are not limited to:• ...
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PHRN Trainee
1 week ago
PHL-Taguig City-Alliance Global Tower, th Ave, Corner th St, Uptown Bonifacio, Philippines Carelon Global Solutions Full time $40,000 - $60,000 per yearPosition Title:PHRN TraineeShift:Job Description:Responsible for serving in an interim basis as a nurse trainee in the USRN Clinical Academy while obtaining NCLEX certification and USRN license prior to being deployed to a USRN function.Primary duties may include, but are not limited to:Attend review and USRN Academy Program for purposes of preparing for the...
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2025 - Cobden & Carter -NCLEX Academy Hiring
7 days ago
PHL-Taguig City-Alliance Global Tower, th Ave, Corner th St, Uptown Bonifacio, Philippines Carelon Global Solutions Full time ₱50,000 - ₱80,000 per yearPosition Title:2025 - Cobden & Carter -NCLEX Academy HiringShift:Job Description:Responsible for serving in an interim basis as a nurse trainee in the USRN Clinical Academy while obtaining NCLEX certification and USRN license prior to being deployed to a USRN function.Primary duties may include, but are not limited to:Attend review and USRN Academy Program...
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2025 - Stark Asia -NCLEX Academy Hiring
7 days ago
PHL-Taguig City-Alliance Global Tower, th Ave, Corner th St, Uptown Bonifacio, Philippines Carelon Global Solutions Full time ₱500,000 - ₱1,500,000 per yearPosition Title:2025 - Stark Asia -NCLEX Academy HiringShift:Job Description:Responsible for serving in an interim basis as a nurse trainee in the USRN Clinical Academy while obtaining NCLEX certification and USRN license prior to being deployed to a USRN function.Primary duties may include, but are not limited to:Attend review and USRN Academy Program for...
