Health Clinical Services Senoir Manager
Gratitude IncHealth Clinical Services Senoir Manager
Job Description
Key Skills
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**JOB TITLE: Health Clinical Services Senior Manager - USRN**
WORK SET UP: Onsite in Taguig
WORK SHIFT: Night shift
Rest Day: Weekends
Location: Taguig Uptown
Salary (Confidential), the final salary offer will depends to the client and project they will be assigned)
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
• Should not be a job hopper who only works for less than a year per com
PRE-SCREENING QUESTIONS:
1. Do you have an active USRN license?
2. How much is your last drawn salary?
3. How much is your salary expectation?
4. Are you amenable to working onsite set up with a shifting schedule in Taguig?
Role
Medical Administrator
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.
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