Position Title: Manager Medical Management Shift: Job Description: Responsible to manage a team of clinicians charged with promoting quality member outcomes, to optimize member benefits, and to promote effective use of resources. 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 steering members to appropriate providers, programs or community resources. Applies clinical knowledge to work with facilities and providers for care-coordination. May also manage appeals for services denied. Hires, trains, coaches, counsels, and evaluates performance of direct reports. Requires current active unrestricted RN license to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States, except in government business where it is preferred, and 5 years acute care clinical experience or any combination of education and experience, which would provide an equivalent background. Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. The following are level distinctions not required for posting. This level typically reflects a new manager, one managing a singular function, a manager with a smaller span of management, or one located in a unit where a higher level of management exists.For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. Care meets innovation Our name translates to “providing full and complete care” and reinforces our commitment to putting people first in all that we do. We specialize in contact center operations (call and chat) and clinical nurse operations for Elevance Health. With four offices in prime locations across the Philippines—two in Manila and two in Iloilo—we boast a talent pool of more than 9,000 associates all working together to improve healthcare operations. We use the right balance of care, technology, data, and expertise to streamline experiences and create value for our clients, people, and community. We also recognize the value that our associates bring, and that is why we are committed to providing the same through competitive compensation and comprehensive benefits such as rewards and recognition programs, health and medical insurance, and best-in-class amenities to keep associates and their families healthy and secure. At Carelon Global Solutions Philippines, we care for those who provide care. Join us today. We celebrate and leverage our associates' limitless skills, talents, unique perspectives, and experiences. By respecting our people's culture and background, we foster a collaborative and purpose-driven workplace where everyone can grow and thrive in their careers. If you are a recent senior high school or college graduate looking to get a head start in your career, we are the right team for you. Our people-first approach supports professional development by providing associates with the right tools and training that align with their aspirations.

Manager Medical Management.

more at elevancehealth.

Databricks - Tech Lead II - GR - 40516-75564 - JR206256

Databricks - Associate Architect II - GR - 40516-75570 -JR206254

Sr Software Engineer III - AI (IND)

similar roles.

Support Staff – Victim Services Division

Medical Director