OPERATIONS MANAGER FOR APPEALS -PHRN
Gratitude IncOPERATIONS MANAGER FOR APPEALS -PHRN
Job Description
Key Skills
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Job Title: Operations Manager for Appeals – PHRN
Shift: Night Shift
Work Set-up: On-site, Bridgetowne, Quezon City
Salary Range: PHP 120,000 – 150,000
Headcount: 1
Start Date: December 31, 2025 / ASAP
Recruitment Process:
• 2 interviews with Operations (virtual)
• Assessment depending on interview recommendations
Line of Business (LOB) Description
Medical necessity review for appeals (claims denied due to medical necessity).
Job Summary
The Operations Manager for Appeals is responsible for overseeing end-to-end operations related to clinical appeals, ensuring alignment with regulatory requirements and industry standards. The role works closely with internal and external stakeholders to drive operational excellence, ensure compliance, and maintain high-quality performance outcomes.
Qualifications
• Bachelor’s Degree in Nursing with an active and valid PHRN license
• At least 1–2 years of managerial experience handling leaders (TLs/Supervisors)
• Experience managing teams handling Clinical Appeals
• Background in appeals, utilization review, or related healthcare management functions
• Strong verbal and written communication skills
• Willing to work on-site with flexible schedules, including US hours and holidays
• Must not be a current or former employee of the client’s organization
Key Responsibilities
• Oversee daily operations and ensure adherence to SLAs and regulatory standards
• Develop and implement process improvement initiatives
• Collaborate with internal teams and clients to enhance service delivery and maintain accurate staffing
• Ensure compliance with HIPAA and other regulatory requirements
Pre-Screening Questions
- Do you have an active PHRN license?
- How many years of experience do you have in managing teams handling Clinical Appeals (healthcare or BPO/CPO setting)?
- How many years of managerial experience do you have?
- Please share your years of experience handling clinical appeals and provide a brief overview of the process.
- Do you have strong knowledge and understanding of HIPAA and other regulatory requirements?
- What is your last drawn salary?
- What is your expected salary?
- Are you amenable to working on-site in Bridgetowne, Quezon City, with a night shift schedule and fixed weekends off?
- When is your earliest possible start date once hired?
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?
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