Operations Manager for Utilization Management - USRN
Gratitude IncOperations Manager for Utilization Management - USRN
Job Description
Key Skills
4 candidate(s) have already applied for this Job. Apply now
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
• Must not be a current or former employee of Concentrix
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
Operations Manager
Timings
Night Shift (Permanent)
Industry
BPO
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.
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 S/4 HANA Finance Consultant
Gratitude Inc2 - 6 Year(s)
Confidential
Manila, Philippines
Quality Manager
Gratitude Inc0 - 1 Year(s)
80 - 110 Thousand p.m
Manila, Philippines
TL Spanish billingual Account -Cognizant
Gratitude Inc3 - 5 Year(s)
100 - 120 Thousand p.m
Manila, Philippines
1 - 2 Year(s)
60 - 100 Thousand p.m
Manila, Philippines
Multilingual Service Desk Analyst (Estonian)
Gratitude Inc0 - 30 Year(s)
60 - 70 Thousand p.m
Manila, Philippines
CSR video sharing account -Cognizant Vertis N
Gratitude Inc1 - 10 Year(s)
25 - 30 Thousand p.m
Manila, Philippines
Lead IT Systems Analyst (Automation) Urgent
Gratitude Inc3 - 8 Year(s)
80 - 150 Thousand p.m
Manila, Philippines
Insurance brokerage account -Cognizant company Taguig
Gratitude Inc2 - 15 Year(s)
10 - 15 Thousand p.m
Manila, Philippines
CSR -Rider support Account COGNIZANT COMPANY
Gratitude Inc2 - 29 Year(s)
30 - 40 Thousand p.m
Manila, Philippines
Travel and Hospitality Account
Gratitude Inc0 - 1 Year(s)
15 - 25 Thousand p.m
Manila, Philippines