EXL

Assistant Manager – Healthcare Operations Management, Case Management Nursing

EXL

full-time

Posted on:

Location Type: Hybrid

Location: Pasay • Philippines

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Job Level

Junior

About the role

  • Oversees the implementation of Highmark Clinical Case Management Support including but not limited to Case Management (CM) screening/Telephonic Outreach/Program Enrollment/Task Support for Case Management and monitors daily performance to ensure business goals are met and compliance with Highmark policies and procedures is maintained.
  • Implements clinical policies & procedures in accordance with NCQA, URAC, state and federal standards and mandates.
  • Serve as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking.
  • Ensure implementation and monitoring of best practice approaches and innovations to better address the member's needs across the continuum of care.
  • Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
  • Manages resources responsible for identification of members, development and implementation of care plans, enhancement of medical appropriateness and quality of care and monitoring.
  • Communicates productivity expectations, balance workload (e.g., daily team meetings to discuss new referrals), monitor efficiency and initiate control measures to minimize variances in workload over time.
  • Ensures the team's understanding and use of information system capability and functionality.

Requirements

  • Active PHRN with minimum 1 year bedside experience.
  • Communication Skills Requirement (B2-C1 in HLEAP)
Benefits
  • Active PHRN with minimum 1 year bedside experience.
  • Communication Skills Requirement (B2-C1 in HLEAP)
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
Case ManagementTelephonic OutreachProgram EnrollmentTask SupportClinical PoliciesQuality of InterventionsCare PlansMonitoringProblem ResolutionCritical Thinking
Soft Skills
Communication SkillsMentoringTeam LeadershipWorkload ManagementProductivity MonitoringConfidentiality AdherenceInterpersonal SkillsProblem SolvingEfficiency ImprovementInnovative Thinking
Certifications
PHRN