Assistant Manager-Utilization Management

6 days ago

Makati City, National Capital Region, Philippines Maxicare Healthcare Corporation Full time ₱1,500,000 - ₱3,000,000 per year

Responsibilities
Operational Execution & Process Improvement

  • Oversee and implement initiatives aimed at improving UM operations, including but not exclusive to provider redirection, cost control, and process automation.
  • Identify inefficiencies in UM workflows and propose data-driven and process improvements.
  • Support the rollout of various UM programs and initiatives
  • Ensure that operational projects align with company goals for medical utilization cost containment.

Data Analysis & Performance Tracking

  • Analyze medical utilization patterns, claims data, provider performance and programs performance and identify cost drivers and areas for improvement.
  • Work with the different key stakeholders to identify requirements such as development of dashboards, reports, and insights that support UM strategies.
  • Monitor and track key metrics such as LOA issuance rates, outlier detection trends, and cost savings achieved.

Stakeholder Coordination

  • Collaborate with other UM, Medical, PNM, and Operations teams to execute projects and align strategies.
  • Provide regular updates to management on operational performance and project outcomes.

Policy Execution & Compliance

  • Implement UM policies related to utilization cost management and ensure adherence across operational workflows.
  • Assist in the formulation and execution of policy changes to enhance cost efficiency without compromising care quality.
  • Ensure compliance with regulatory requirements and internal guidelines.

Risk Management & Quality Assurance

  • Monitor patient outcomes to ensure that cost-control measures do not negatively impact healthcare quality.
  • Identify and mitigate risks associated with high-cost cases and chronic disease management.
  • Support UM leadership in implementing corrective actions when utilization patterns indicate potential inefficiencies or risks.

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