Operations Manager for Utilization Management - USRN

Gratitude Inc

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Operations Manager for Utilization Management - USRN

1-2 Year(s)

150 - 180 Thousand p.m

Quezon Calabarzon

Job Description

Key Skills

Utilisation management HIPPA Clinical Denials and appeals InterQual® or MCG

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JOB TITLE: Operations Manager for Utilization Management - USRN

LOCATION: Onsite | Bridgetowne, Quezon City

SCHEDULE: Night Shift

SALARY RANGE: ₱150,000 – ₱180,000

START DATE: December 31, 2025 / ASAP

ROLE OVERVIEW

We are seeking an experienced Operations Manager to lead our Utilization Management operations. This critical role requires a licensed US Registered Nurse with proven leadership experience to oversee UM operations, ensure regulatory compliance, and drive team performance. You will work closely with cross-functional stakeholders to maintain high-quality healthcare management standards while managing clinical denials and utilization review processes.

KEY RESPONSIBILITIES

Oversee daily Utilization Management operations ensuring smooth workflow

Ensure compliance with SLAs and regulatory standards

Monitor and maintain operational efficiency across all UM processes

Develop and implement process improvement initiatives

Identify opportunities for operational excellence

Drive continuous improvement in service delivery

Manage team performance and conduct regular evaluations

Optimize resource allocation and staffing levels

Coach and develop team leads and supervisors

Foster a high-performance culture focused on quality outcomes

Collaborate with internal teams and client stakeholders to enhance service delivery

Maintain accurate staffing and capacity planning

Build strong relationships to drive operational success

Ensure strict adherence to HIPAA and other regulatory requirements

Maintain compliance with medical guidelines (MCG, InterQual, NCQA, ODG)

Uphold quality standards in all utilization management decisions

REQUIRED QUALIFICATIONS AND SKILLS

Bachelor's Degree in Nursing required

Active and valid USRN (US Registered Nurse) license - MANDATORY

Excellent verbal and written communication skills

Strong leadership and team management capabilities

Strategic thinking with process improvement mindset

Strategic operational management

Clinical denials and appeals management expertise

Regulatory compliance and risk management

Team development and performance optimization

Healthcare management process knowledge

Stakeholder management and communication

Data-driven decision making

Relevant Experience:

Minimum 1-2 years in a managerial role supervising leaders, team leads, or supervisors

Proven experience managing teams handling Utilization Management and clinical denials

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

Well-versed in Medical Guidelines including MCG, InterQual, NCQA, and ODG

Strong knowledge of HIPAA and other regulatory requirements

Understanding of industry standards and compliance protocols

Availability:

Willing to work onsite in Bridgetowne, Quezon City

Available to start by December 31, 2025 or immediately

APPLICATION SCREENING QUESTIONS

To expedite your application, please kindly answer the following:

Do you have an active USRN license?

How many years of experience do you have managing teams handling Utilization Management and clinical denials in healthcare or BPO/CPO settings?

How many years of managerial experience do you have?

Please provide your years of experience in handling utilization management and clinical appeals, and share a brief overview of your process experience.

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

Please rate your knowledge and expertise in Medical Guidelines (MCG, InterQual, NCQA, ODG) from 1 to 10, with 10 being the highest.

What are your salary expectations?

When can you start once hired?

Join us in making a difference in healthcare utilization management. If you're a licensed USRN with strong leadership experience and expertise in utilization management, we want to hear from you!

Apply now and lead our UM operations to excellence!

Role

Operations Manager

Timings

Night Shift (Permanent)

Industry

Medical / Healthcare / Hospital

Work Mode

Work from office

Process

Voice

Functional Area

ITES / BPO / Customer Service

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.

Chioma Uyigue

Recruiter - Gratitude Inc

NA, nigeria

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