Operations Manager – Utilization Management

2 weeks ago


Quezon City, National Capital Region, Philippines Comrise Full time ₱600,000 - ₱800,000 per year

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.

Key Responsibilities

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

Job Description:

  • Bachelor's Degree in Nursing Graduate.
  • US Registered Nurse (Active License; Compact License).
  • Minimum 1 year in a Manager role.
  • Well versed in Medical Guidelines (e.g. MCG, Interqual, NCQA, ODG).
  • Experience in managing teams handling Clinical Appeals.

Candidate Profile:

  • Must be a USRN
    with an
    active and unrestricted license
    .
  • With
    extensive experience in Utilization Management (UM) core functions
    .


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