Health Clinical Services Senior Manager - USRN
Gratitude IncHealth Clinical Services Senior Manager - USRN
Job Description
Key Skills
0 candidate(s) have already applied for this Job. Apply now
WORK SET UP: Onsite in Taguig
WORK SHIFT: Night shift
Rest Day: Weekends
Location: Taguig Uptown Bonifacio Tower 3
Salary budget: Negotiable
Ready to join the team of empowered people? We’re looking for candidates with the following skills and experience for this role. Do you fit the profile? If you do, we’d love to hear from you! In adherence to Accenture’s process of Identity Verification, your resume or CV must include your photo to ensure the accuracy of your application.
Responsibilities:
Oversees staff whose teams’ primary duties may include, but are not limited to:
• Conducts pre-service, concurrent, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
• Service requests may be from inbound calls and facsimile.
• Outbound calls to the provider may be required to gather additional information that may be needed.
• Other staff responsibilities may include review and analysis of post-service claims utilizing the member’s benefit contract and health plan guidelines.
• Completes review of pended claims post-service for either Medical Necessity or Contractual Reviews.
SKILL AND QUALIFICATIONS:
• At least 12 years of relevant experience and 10 years of supervisory experience
• Holds current and unrestricted US Registered Nurse license. No state-specific RN licensure required.
• BPO experience should be any account (Health account experience is only a plus, but not required)
• Work Background/Experience in General: Must be open to BPO & Non-BPO Experience
• Open for those applicants who are currently in Philippines and already have the right to live and work in this country are eligible for this role
• Must have no recent or active application with Accenture
• Should not be a job hopper who only works for less than a year per company
Role
Any Other
Timings
Night Shift (Permanent)
Industry
Other
Work Mode
Work from office
Functional Area
Any Other
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 Master Data Management (MDM) Lead
Gratitude Inc5 - 40 Year(s)
110 - 120 Thousand p.m
Manila, Philippines
QA Analytics HMO. VERY URGENT
Gratitude Inc2 - 5 Year(s)
35 - 40 Thousand p.m
Manila, Philippines
Training Manager Service Desk
Gratitude Inc6 - 8 Year(s)
85 - 95 Thousand p.m
Manila, Philippines
Japanese (Travel
Gratitude Inc1 - 10 Year(s)
70 - 75 Thousand p.m
Manila, Philippines
Looker Developer Lead
Gratitude Inc5 - 25 Year(s)
190 - 200 Thousand p.m
Manila, Philippines
Operations Supervisor
Gratitude Inc1 - 30 Year(s)
25 - 35 Thousand p.m
Manila, Philippines
NOC Mainframe Operator
Gratitude Inc2 - 35 Year(s)
75 - 80 Thousand p.m
Manila, Philippines
Japanese Tech Bilingual - Java Spring Boot (Manila)
Gratitude Inc1 - 3 Year(s)
50 - 80 Thousand p.m
Manila, Philippines
Japanese Tech Bilingual - Java Spring Boot
Gratitude Inc1 - 5 Year(s)
Confidential
Manila, Philippines
Quality Manager
Gratitude Inc1 - 30 Year(s)
80 - 110 Thousand p.m
Manila, Philippines