usrn Manager (taguig)Legato Health Technologies

Responsibilities:
Responsible to manage a team of clinicians charged with promoting quality member outcomes, to optimize member benefits, and to promote effective use of resources. Primaryduties may include, but are not limited to:
Ensures adherence to medical policy and member benefits in providing service that is medically appropriate, high quality, and cost effective.
Areas managed may include authorizing inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources.
Applies clinical knowledge to work with facilities and providers for care-coordination. May also manage appeals for services denied.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Qualifications:
At least 5 years cumulative bpo experience in a healthcare information management account OR bedside clinical experience in a hospital / clinical setting OR any combination of both; Must have at least 3 years of supervisory / managerial experience leading a team in a healthcare information management account
At least 1 year Utilization Management, Prior Authorization or Post Service Clinical Claims Review account experience is an advantage
Requires current active unrestricted USRN license to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States
Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Available for a temporaty work from home set up but is willing to work at Bonifacio Global City, Taguig once work onsite resumes.
To expedite the process of your application, please have your government numbers / IDs ready (SSS, TIN Philhealth, Pagibig) and NBI Clearance. For candidates applying for Clinical Operations, please also prepare your PRC and/or USRN license numbers / IDs ready.
Questions? Call 0917-6LEGATO or send us a message at our page at facebook.com/LegatoPhilippines
Legato Health Technologies

Taguig City, Metro Manila
Permanent
Full-time