Operation Manager for Appeals PHRN

Gratitude Inc

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5 days ago

Operation Manager for Appeals PHRN

1-10 Year(s)

120 - 150 Thousand p.m

Manila (Bridgetown quezon City)

Job Description

Key Skills

PHRN BSN Management Review and Clinical Appeals

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Job Title: Operations Manager for Appeals - PHRN

Shift: Night shift

Work Set-up: On-site in Bridgetowne, Quezon City

Salary range: 120K to 150K

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: 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 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 PHRN

• Must have at least 1 or 2 years in a managerial role handling leaders/ TLs/ Supervisors

• Experience in managing teams handling Clinical Appeals

• Experience in handling appeals, utilization review, or related healthcare management functions

• Excellent verbal and written communication skills

• Willingness to work on-site with flexible schedules, including US hours and Holiday

KEY RESPONSIBILITIES:

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

• Developer and implement process improvement initiatives.

• 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

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