USRN Senior Manager
Full-time
Gratitude Inc
Job Title: Health Clinical Services Senior Manager – USRN
Work Setup: Onsite
Location: Uptown Bonifacio, Taguig
Work Schedule: Night Shift | Weekends Off
Job Summary:
We are seeking an experienced US Registered Nurse (USRN) to lead clinical review operations and manage high-performing healthcare teams. This role oversees utilization management, medical necessity reviews, and claims analysis while ensuring compliance with US healthcare standards and policies.
Key Responsibilities:
- Lead and oversee clinical teams performing utilization and medical necessity reviews
- Review pre-service, concurrent, retrospective, and out-of-network cases
- Ensure compliance with medical policies, benefits, and member eligibility
- Oversee post-service and pended claims review
- Coordinate with healthcare providers to obtain required clinical information
- Maintain quality, accuracy, and regulatory compliance across all reviews
Qualifications & Requirements:
- Active and unrestricted USRN license (any US state)
- Minimum 12 years of clinical experience
- At least 10 years of supervisory or leadership experience
- Open to both BPO and non-BPO backgrounds
- Must have the right to live and work in the Philippines
- No active or recent application with the same employer
- Stable employment history (no frequent job changes)
Additional Notes:
- Onsite role based in Taguig
- Night shift schedule with weekends off
- Salary details to be discussed during the selection process
Vacancy posted 6 days ago
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