Operation Manager Utilization Management USRN
Gratitude IncOperation Manager Utilization Management USRN
Job Description
Key Skills
0 candidate(s) have already applied for this Job. Apply now
Job Title: Operations Manager for Utilization Management - USRN
Shift: Night shift
Work Set-up: On-site in Bridgetowne, Quezon City
Salary range: 150K to 180K
HC: 1
Start date: Dec 31, 2025/ ASAP
Recruitment Process: 2 interviews with Ops/virtual, Assessment depends on the recommendations after the interviews
LOB DESCRIPTION: Utilization Management - medical necessity approval/ denials for pre-service, retrospective, and concurrent services.
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.
QUALIFICATIONS:
• Bachelor's Degree in Nursing with an active and valid license in USRN
• Must have at least 1 or 2 years in a managerial role handling leaders/ TLs/ Supervisors
• Experience in managing teams handling Utilization Management and clinical denials.
• Experience in handling appeals denials, utilization review, or related healthcare management functions
• Well-versed in Medical Guidelines (e.g MCG, InterQual, NCQA, ODG)
• Excellent verbal and written communication skills
• Willingness to work on-site with flexible schedules, including US hours and holidays
KEY RESPONSIBILITIES:
• Oversee daily operations and ensure compliance with SLAs and regulatory standards.
• Developer 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.
Role
Nursing - Management
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.
Interview Tips
- Giving the VNA round?
- What are the most important skills you acquired as a Soft Skills/VNA trainer?
- How would you handle an irate customer?
Get the Best Jobs
on your Fingertips
Similar Jobs
SAP Order-to-Cash (OTC) Lead
Gratitude Inc8 - 9 Year(s)
120 - 150 Thousand p.m
Manila, Philippines
5 - 10 Year(s)
170 - 180 Thousand p.m
Manila, Philippines
Bilingual Team Member - Japanese and English
Gratitude Inc0 - 2 Year(s)
Confidential
Manila, Philippines
mid Sharepoint Developer
Gratitude Inc3 - 15 Year(s)
55 - 60 Thousand p.m
Manila, Philippines
Customer service representative
Gratitude Inc0 - 4 Year(s)
Confidential
Manila, Philippines
HGS Bridgertowne -CSR Financial account
Gratitude Inc1 - 24 Year(s)
20 - 25 Thousand p.m
Manila, Philippines
OpentextExstream Developer
Gratitude Inc3 - 10 Year(s)
90 - 120 Thousand p.m
Manila, Philippines
Join Our High Priority Banking Account – Apply Today!
Gratitude Inc0 - 2 Year(s)
10 - 30 Thousand p.m
Manila, Philippines
Spanish Bilingual CSR -WNS Company
Gratitude Inc2 - 17 Year(s)
95 - 100 Thousand p.m
Manila, Philippines
Spanish Bilingual CSR -WNS Company
Gratitude Inc2 - 17 Year(s)
95 - 100 Thousand p.m
Manila, Philippines