• Sets team direction, resolves problems and provides guidance to members of own team.
• Reviews service requests to ensure compliance with applicable criteria.
• Responsible for conducting medical management review activities.
• Ensure member access to medically necessary, quality healthcare in a cost-effective setting according to contract.
• Adapts departmental plans and priorities to address business and operational challenges.
• Active USRN License.
• At least 2 years of BPO Healthcare experience in a leadership role.
• Help create, launch and drive critical account initiatives and programs.
• Provides inputs to policies and processes impacting the operations.
• Manages a team of nurses and allied Healthcare professionals.
• This position will be working with an American pharmacy benefit manager and health care provider.
• Working schedule: Shifting Schedule
• Complete details will provide by our Recruiters.
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