Job Role: - Operations Manager ? Utilization Management
Job Location: - Manila, Philippines
Experience: -10+ Years
Roles & Responsibilities - Oversee daily Utilization Management (UM) operations for preservice, retrospective, and concurrent review activities.
- Ensure compliance with SLAs, policies, medical guidelines, and regulatory requirements.
- Lead team performance management, staffing accuracy, and resource allocation.
- Drive process improvement initiatives to enhance operational efficiency and service quality.
- Collaborate with internal stakeholders to support smooth operational delivery.
- Ensure adherence to HIPAA and all applicable regulatory standards.
Skills & Requirements - Bachelor?s Degree in Nursing.
- Active US Registered Nurse license (Compact License preferred).
- Minimum 1 year of experience in an Operations Manager or similar leadership role.
- Strong knowledge of medical necessity and UM guidelines (MCG, InterQual, NCQA, ODG).
- Experience leading teams involved in clinical appeals or utilization review processes.
- Ability to manage large teams (up to 1 OM and 100 staff).
- Strong analytical, communication, and decision-making skills.
