Deskripsi Pekerjaan
Are you an experienced US Registered Nurse looking to transition into a leadership role within a global healthcare management firm? Omega Healthcare Management Services Inc. is seeking a dynamic USRN Utilization Review Team Lead to join our high-performing team in Pasig City. In this pivotal role, you will act as the bridge between clinical excellence and operational efficiency.
As a Team Lead, you will provide oversight for prior authorization processes, clinical documentation review, and complex claims resolution. You will be responsible for fostering a high-performance culture, ensuring that your team meets stringent compliance standards, quality benchmarks, and KPI targets. If you are a proactive leader with a strong background in utilization review and a passion for nursing leadership, we want to hear from you.
We offer a competitive compensation package and the opportunity to grow your career within an international company that values talent, innovation, and integrity. Join us in shaping the future of healthcare support services.
Tanggung Jawab
- Lead, mentor, and supervise a team of Utilization Review Nurses to ensure optimal productivity and clinical accuracy.
- Monitor and evaluate team performance against KPIs, including turnaround time, accuracy, and adherence to medical necessity guidelines.
- Oversee the end-to-end prior authorization process to ensure seamless clinical operations.
- Conduct regular audits of documentation to maintain high standards of quality and compliance with regulatory requirements.
- Act as a subject matter expert for escalated claims, clinical denials, and complex case resolutions.
- Facilitate team meetings, training sessions, and performance reviews to foster continuous professional development.
- Collaborate with stakeholders to refine processes, improve clinical outcomes, and enhance operational workflows.
Kualifikasi
- Active US Registered Nurse (USRN) license in good standing.
- Minimum of 3-5 years of experience in Utilization Review, Case Management, or a related clinical role.
- Proven experience in a supervisory or team lead capacity within a BPO or Healthcare environment.
- Deep understanding of medical necessity criteria (e.g., InterQual or Milliman Care Guidelines).
- Expertise in health insurance processes, including prior authorizations and denials management.
- Excellent communication, interpersonal, and analytical skills.
- Strong computer literacy and proficiency in Electronic Medical Records (EMR) systems.