• Manage daily SLA and KPI performance, including turnaround time, quality, productivity, and documentation accuracy.

• Conduct team huddles, interval monitoring, root cause analysis (RCA), and performance recovery planning.

• Ensure strict compliance with HIPAA regulations and Protected Health Information (PHI) requirements.

• Lead clinical quality assurance activities, including audits, calibration sessions, coaching, and documentation reviews.

• Develop, mentor, and manage Registered Nurses (RNs), clinical associates, and team leaders.

• Oversee competency programs, preceptorship, continuing education (CE) tracking, and professional license validity.

• Collaborate with Workforce Management (WFM), Talent Acquisition (TA), Quality Assurance (QA), and client stakeholders.

• Translate clinical protocol updates into practical workflows, operational guidelines, and training materials.

• Monitor operational performance and implement continuous improvement initiatives to achieve client expectations.

Qualifications

• Bachelor of Science in Nursing (BSN) graduate.

• Active Philippine Registered Nurse (PHRN) license.

• Active, unrestricted USRN license with NCLEX passed.

• Minimum 5 years of clinical and healthcare operations experience.

• Minimum 3 years of team leadership experience in healthcare BPO or shared services.

• Strong knowledge of US managed care, Utilization Management (UM), Case Management (CM), CMS, and HIPAA requirements.

• Proven experience managing SLAs, KPIs, clinical quality, and operational performance.

• Current experience managing Utilization Review (UR) operations, with a strong background in UR/UM.

• Experience in UM, CM, Health Risk Assessment (HRA), triage, or payer operations is preferred.

• Familiarity with URAC and NCQA standards is an advantage.

• Clinical training or education experience is preferred.

• Willingness to work onsite at Vertis North, Quezon City, on a US day shift.

License Requirements

The Philippine RN and USRN licenses must be active. Candidates whose licenses are nearing expiration must be willing to renew them.

Required Assessment

Candidates must complete an on-the-spot clinical review writing assessment during the interview. A laptop or desktop computer is required to complete the assessment. Candidates must be informed of this requirement in advance.

Recruitment Process

1. Profile Validation

2. Profile Review

3. Talent Acquisition (TA) Interview

4. Hiring Manager (HM) Interview

5. Client Interview

Important Hiring Restrictions

Former Teleperformance (TP) employees are not eligible for rehire, either directly or through a third party. Candidates with previous employment at PSG Global, Majorel, or Aegis are also ineligible under the client's hiring restrictions.

Pre-Screening Questions

1. Educational Attainment: What is your highest educational qualification?

2. Clinical and Healthcare Operations Experience: How many years of experience do you have?

3. Leadership Experience: How many years of team leadership experience do you have in healthcare BPO or shared services?

4. UR/UM Background: Do you have experience in Utilization Review (UR) and Utilization Management (UM)? Please provide details about your current or most recent responsibilities.

5. Licenses: Do you hold an active Philippine RN (PHRN) license and an active, unrestricted USRN license? When do your licenses expire?

6. Training Experience: How many years of experience do you have in clinical training or education?

7. Last Drawn Salary: What was your most recent salary?

8. Expected Salary: What is your expected salary?

9. Work Arrangement: Are you willing to work onsite at Vertis North, Quezon City, on a US day shift?

10. Assessment: Are you able to complete an on-the-spot clinical review writing assessment using a laptop or desktop computer?