DE031312 - Health Clinical Services Assoc Manager
Accenture
Date: 21 hours ago
City: Quezon City
Contract type: Full time
---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 Assoc Manager
WORK SETUP: RTO
Responsibilities:
O Perform out of network reviews
O Determine the appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts
O Outbound calls to the provider may be required to gather additional information as needed to perform clinical review
Project Shift Schedule: Night Shift
Project Rest Day: Weekends
Project/Team Location: Gateway Tower 2
SKILL AND QUALIFICATIONS
POSITION TITLE: Health Clinical Services Assoc Manager
WORK SETUP: RTO
Responsibilities:
- Oversees staff and Team Leads in either Utilization Management (UM) and/or appeals whose primary duties may include:
O Perform out of network reviews
O Determine the appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts
O Outbound calls to the provider may be required to gather additional information as needed to perform clinical review
- Provides leadership, oversight, guidance and mentor staff and team leads with making clinical decisions, which have major day-to-day impact in area of responsibility, and may influence direction of other areas.
- Allocates resources and responsibilities across team to deliver business results and develop team members.
- Manages and ensures consistent application of human resource processes including career/professional development support, coaching and performance management within area of responsibility.
- Initiates and promotes continuous improvement programs across sphere of influence.
- Responsible for maintaining contractual, regulatory and accreditation compliance by knowing, understanding, correctly interpreting, and accurately applying requirements, regulations, and standards. Reports suspected or confirmed issues timely as the situation warrants to the Compli
Project Shift Schedule: Night Shift
Project Rest Day: Weekends
Project/Team Location: Gateway Tower 2
SKILL AND QUALIFICATIONS
- At least 7 years relevant experience and 5 years supervisory- (Supervisory experience can be a combination of both BPO and clinical)
- 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)
- Excellent written and verbal communication skills in English
- Strong proficiency in Microsoft Excel, Word and PPT
- Strong customer service focus
- Ability to empathize
- Prioritizing customer needs
- Listening, patience & action oriented
- Good understanding of phone etiquette
How to apply
To apply for this job you need to authorize on our website. If you don't have an account yet, please register.
Post a resumeSimilar jobs
PCC Director III
The Philippine Competition Commission,
Quezon City
17 hours ago
Job Grade:
JG 15
Plantilla Item No.:
PHCC-DIR3-3-2016
Employment Status:
Permanent
Office/Division:
Communications and Knowledge Management Office/Office of the Director
Minimum Qualification Requirements (based on CSC standards):
Education:
Master's Degree or its equivalent, or Certificate of Leadership and Management from the CSC
Experience:
5 years of supervisory/management experience
Training:
120 hours of supervisory/management learning and development intervention; OR 40 hours...
HR Associate for Training and Recruitment
Webcast Technologies Inc.,
Quezon City
2 days ago
We are seeking a highly motivated and organized Associate to handle Training and Recruitment. This position will be responsible for coordinating and supporting both our company-wide learning and development programs and our end-to-end recruitment and talent management processes. The ideal candidate is a proactive self-starter with a passion for helping others grow and a keen eye for identifying top talent.Coordinate...
System Administrator
STRADCOM Corporation,
Quezon City
4 days ago
Manage and support core infrastructure systems including On-Premise servers (AD, DNS, DHCP, Exchange, virtualization, Windows/Linux) and cloud services on Microsoft Azure (Azure AD, VMs, storage, and networking);Create, update, and manage user accounts, mailboxes, and access permissions across both local and cloud environments. Provide support for Microsoft 365 services, including Outlook and Office apps;Manages the day-to-day operations of LTO-IT system by...
