Operations Manager for Utilization Management

1 day ago

Quezon City, National Capital Region, Philippines BEWAHARVEST Full time ₱150,000 - ₱180,000 per year

Job Title: Operations Manager for Utilization Management - USRN

Shift: Night shift

Work Set-up: On-site in Bridgetowne, Quezon City

Salary range: 150K to 180K

Start date: Dec 31, 2025/ ASAP

LOB DESCRIPTION: Utilization Management - medical necessity approval/ denials for pre-service, retrospective, and concurrent services.

JOB SUMMARY:

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

QUALIFICATIONS:


• Bachelor's Degree in Nursing with an active and valid license in USRN


• Must have at least 1 or 2 years in a managerial role handling leaders/ TLs/ Supervisors


• Experience in managing teams handling Utilization Management and clinical denials.


• Experience in handling appeals denials, utilization review, or related healthcare management functions


• Well-versed in Medical Guidelines (e.g MCG, InterQual, NCQA, ODG)


• Excellent verbal and written communication skills


• Willingness to work on-site with flexible schedules, including US hours and holidays


• Must not be a current or former employee of Concentrix

KEY RESPONSIBILITIES:


• Oversee daily operations and ensure compliance with SLAs and regulatory standards.


• Developer and implement process improvement initiatives.


• Manage team performance and resource allocation,


• Collaborate with internal and client stakeholders to enhance service delivery and maintain accurate staffing.


• Ensure adherence to HIPAA and other regulatory requirements.

  1. Do you have an active USRN license?

  2. How many years of experience do you have in managing teams handling Utilization management and clinical denials for a healthcare or BPO/CPO setting?

  3. How many years of managerial experience do you have?

  4. Please provide your years of experience in handling utilization management & clinical appeals, and share a brief experience on the process.

  5. Do you have strong knowledge and understanding of HIPAA and other regulatory requirements?

  6. Please rate your knowledge and expertise in Medical Guidelines such as MCG, InterQual, NCQA, ODG, from 1 to 10, 10 being the highest.

  7. How much is your last drawn salary?

  8. How much is your salary expectation?

  9. Are you amenable to working onsite in Bridgetowne, Quezon City, with a night shift and fixed weekends off schedule?

  10. When can you start once hired?

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