ESSENTIAL RESPONSIBILITIES Make coverage determinations by evaluating physician requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to ensure claims are properly routed and paid. Conduct research beyond
Utilization Management (UM) Operations Supervisor Work Set-up: Onsite - Potential to WFH after training Location: Valero, Makati City Schedule: Graveyard | Shifting Hours Position Summary The Utilization Management (UM) Operations Supervisor is responsible for overseeing the daily operations
Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards. Roles and
Team Leader for Utilization Management Healthcare Operations Work Set-up: Onsite - Potential to WFH after training Location: Valero, Makati City Schedule: Graveyard | Shifting Hours Position Summary The Utilization Management Operations Team Leader is responsible for leading the
Description HealthEdge® offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an increasingly competitive market. Were experiencing strong market momentum, with a growing number of health plans choosing HealthEdge to modernize
We are looking for a USRN Utilization Review Specialist responsible for reviewing clinical information, medical records, and patient cases to determine the medical necessity, appropriateness, and level of care based on established clinical guidelines and payer requirements. The
USRN Team Lead – Active USRN & PHRN with BPO Team Lead and Utilization Review Experience Required Work Setup: Onsite – Ortigas, Manila Shift: Nightshift Salary Package: Up to PHP 90,000 (depending on experience) Start Date: ASAP We are currently hiring
USRN Team Lead – Active USRN & PHRN with BPO Team Lead and Utilization Review Experience Required Work Setup: Onsite – Ortigas, Manila Shift: Nightshift Salary Package: Up to PHP 90,000 (depending on experience) Start Date: ASAP We are currently hiring
At EY, you’ll have the chance to build a career as unique as you are, with the global scale, support, inclusive culture and technology to become the best version of you. And we’re counting on your
Job Overview Project Management Analysts (PMA) are an integral part of clinical trial delivery, liaising with clinical teams to improve patients’ lives by bringing new drugs to the market faster. The PMA works in partnership with
Work ScheduleStandard (Mon-Fri) Environmental ConditionsOffice Job Description Join Us as a Senior Clinical Research Associate (Level I) – Make an Impact at the Forefront of Innovation We have successfully supported the top 50 pharmaceutical companies and
The Treasury Manager oversees the day-to-day activities in the department. Responsible for monitoring, planning, and managing efficient utilization of cash and financial services of the Company. Administrative Manages the day-to-day operations of the Treasury Department; Manages internet
About Analog Devices Analog Devices, Inc. (NASDAQ: ADI) is a global semiconductor leader that bridges the physical and digital worlds to enable breakthroughs at the Intelligent Edge. ADI combines analog, digital, AI, and software technologies into
Job Description:At Remitly, we believe everyone deserves the freedom to access, move, and manage their money wherever life takes them. Since 2011, weve tirelessly delivered on our promise to customers sending money globally, providing secure, simple,
OUR STORY At STMicroelectronics, we believe in the power of technology to drive innovation and make a positive impact on people, businesses, and society. As a global semiconductor company, our advanced technologies and chips form the
At Johnson & Johnson,we believe health is everything. Our strength in healthcare innovation empowers us to build aworld where complex diseases are prevented, treated, and cured,where treatments are smarter and less invasive, andsolutions are personal.Through our
SPECIFIC DUTIES AND RESPONSIBILITIES Develop, enhance, and maintain backend services and APIs using Java 21, Spring Framework 5/6, and Spring Boot 3/4, following industry best practices. Design, implement, and document RESTful APIs, ensuring reliable integration with
Job Description This role will ensure delivery for incident recovery, network changes and adherence to configuration standards. The Network Engineer needs to apply technical expertise in routing and switching (Cisco IOS and Nexus especially) and load-balancing
What Customer Service Operations contributes to Cardinal Health Customer Service is responsible for establishing, maintaining and enhancing customer business through contract administration, customer orders, and problem resolution. Customer Service Operations is responsible for providing services to
At JTI we celebrate differences, and everyone truly belongs. 46,000 people from all over the world are continuously building their unique success story with us. 83% of employees feel happy working at JTI. To make a