Health Clinical Services Senoir Manager

Gratitude Inc

819 Views

2 months ago

Health Clinical Services Senoir Manager

12-15 Year(s)

Manila (Taguig)

Job Description

Key Skills

USRN License USRN Manager

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**JOB TITLE: Health Clinical Services Senior Manager - USRN**

WORK SET UP: Onsite in Taguig

WORK SHIFT: Night shift

Rest Day: Weekends

Location: Taguig Uptown

Salary (Confidential), the final salary offer will depends to the client and project they will be assigned)

Responsibilities:

Oversees staff whose teams’ primary duties may include, but are not limited to:

• Conducts pre-service, concurrent, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.

• Service requests may be from inbound calls and facsimile.

• Outbound calls to the provider may be required to gather additional information that may be needed.

• Other staff responsibilities may include review and analysis of post-service claims utilizing the member’s benefit contract and health plan guidelines.

• Completes review of pended claims post-service for either Medical Necessity or Contractual Reviews.

SKILL AND QUALIFICATIONS:

• At least 12 years of relevant experience and 10 years of supervisory experience

• Holds current and unrestricted US Registered Nurse license. No state-specific RN licensure required.

• BPO experience should be any account (Health account experience is only a plus, but not required)

• Work Background/Experience in General: Must be open to BPO & Non-BPO Experience

• Should not be a job hopper who only works for less than a year per com

PRE-SCREENING QUESTIONS:

1. Do you have an active USRN license?

2. How much is your last drawn salary?

3. How much is your salary expectation?

4. Are you amenable to working onsite set up with a shifting schedule in Taguig?

Role

Medical Administrator

Timings

Night Shift (Permanent)

Industry

BPO

Work Mode

Work from office

Functional Area

Medical Professional / Healthcare Practitioner / Technician

Note: Myglit doesn't charge any money from candidates. If you have been asked to pay money to get this job then report to us immediately at support@myglit.com.

Tolulope Edun

Recruiter - Gratitude Inc

NA, nigeria

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Manila, Philippines

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