Operations Manager – Clinical Appeals

Operations Manager for Appeals - PHRNLOB DESCRIPTION: Medical necessity review for appeals (Claims denied due to medical necessity)JOB SUMMARY:The Operations Manager for Appeals is responsible for managing and overseeing operations related to clinical appeals, ensuring compliance with industry standards and regulatory requirements. The role involves close...

Job Title: PHRN – Appeals & Denials NurseWork Setup:On-site, Bridgetowne, Quezon CityShift:Night ShiftSalary Package:PHP 50,762 (Basic: 43,762 + 7,000 Allowance)Signing Bonus:Released on first payout for candidates who can join onDecember 9or immediatelyTarget Start Date:December 9, 2025Headcount:12Role SummaryThe PHRN Appeals & Denials Nurse is...

Job Title: PHRN CLINICAL TRAINERShift: Night shiftWork Set-up: On-site in Bridgetowne, Quezon CityStart date: Dec 31, 2025/ ASAPRecruitment Process: 2 Virtual interview processesQUALIFICATIONS:• Bachelor's Degree in Nursing with an active and valid license in PHRN• Must have at least 2 years experience in utilization management and medical necessity...

HIRING: Clinical Operations Manager (PHRN / USRN)Join a leading healthcare BPO organization and take the next step in your leadership career.POSITION 1: Clinical Operations Manager (PHRN)Compensation Package:₱150,000.00 – Base Rate₱5,000.00 – Program-Specific Allowance₱2,800.00 – Non-Taxable AllowanceTotal Compensation Package: ₱157,800.00 per...

Job Title: Operations Manager for Utilization Management - USRNShift: Night shiftWork Set-up: On-site in Bridgetowne, Quezon CitySalary range: 150K to 180KStart date: Dec 31, 2025/ ASAPLOB DESCRIPTION: Utilization Management - medical necessity approval/ denials for pre-service, retrospective, and concurrent services.JOB SUMMARY:The Operations Manager for...

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.Key Responsibilities:Oversee daily operations and ensure...

Job Title:Operations Manager for Utilization Management – USRNWork Setup:On-site (Bridgetowne, Quezon City)Shift:Night ShiftSalary Range:₱150,000–₱180,000Description:Utilization Management (UM):Handles medical necessity reviews for pre-service, concurrent, and retrospective cases, including approval and denial decision-making.Job Description:The...

Manage the overall operations of the clinic, including scheduling, staffing, and resource allocationEnsure compliance with all relevant healthcare regulations and standardsDevelop and implement policies and procedures to optimize clinic workflows and patient experienceOversee the clinic's financial management, including budgeting, billing, and cost...

Are you a high-performing operations leader who thrives on driving efficiency, managing teams, and  getting things done? We're looking for a Clinic Manager who's not just strategic on paper — but  relentlessly hands-on in execution.At the helm of our clinic, you'll be the engine that powers daily operations, ensuring our frontline  healthcare team can...

Duties and Responsibilities:Oversee day-to-day operations of the Victoria Skin Laser Care Center Inc.Ensure clinic processes are followed in accordance with company standards and regulatory compliance.Develop and implement operational protocols and service workflows for efficiency.Monitor inventory levels of medical/aesthetic supplies and...