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DE029835 - Health Clinical Services Senior Manager

Health Clinical Services Senior Manager | Full time | Experience: 12-14 years
Job No. CXO-129983-S59145 | Taguig
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---ONLY THOSE APPLICANTS WHO ALREADY HAVE THE RIGHT TO LIVE AND WORK IN THIS COUNTRY ARE ELIGIBLE TO APPLY FOR THIS ROLE--- POSITION TITLE: Health Clinical Services Senior Manager WORK SETUP: RTO 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 be 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. OTHERS: Project Shift Schedule: Night Shift Project Rest Day: Weekends Project/Team Location: Taguig Uptown Bonifacio Tower 3
SKILL AND QUALIFICATIONS: • At least 12 years relevant experience and 10 years supervisory • 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

Taguig

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