Care Management US RN Sr Team Lead
Manila, Philippines
1d ago

Job description

Responsible to manage a team of clinicians, up to 155 for voice or 76 for non-voice, charged with promoting quality member outcomes, to optimize member benefits, and to promote effective use of resources operating in two shifts across the Care Management operation.

Primary duties 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 may steer members to appropriate providers, programs or community resources.

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