BPO Senior Manager

NTT
Florida
Workplace: RemoteFull timeUSD 93,600+ annuallyFunction: Solutions Engineering & Sales EngineeringExperience: 5+ yearsSkills: ["Leadership","Coaching","Analytical thinking","Communication","Independent work"]

Lead a remote clinical review team that handles appeals and utilization management, ensuring decisions are accurate, timely, and compliant with state/federal rules, NCQA standards, and customer requirements. Serve as a clinical subject matter expert, coach reviewers, monitor performance and quality metrics, manage case assignments, and oversee documentation and reporting for complex medical-necessity and appeal determinations.

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NTT
NTT
1 week ago

BPO Senior Manager

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Last checked: 19 hours agoStatus: Live

Job Summary

Lead a remote clinical review team that handles appeals and utilization management, ensuring decisions are accurate, timely, and compliant with state/federal rules, NCQA standards, and customer requirements. Serve as a clinical subject matter expert, coach reviewers, monitor performance and quality metrics, manage case assignments, and oversee documentation and reporting for complex medical-necessity and appeal determinations.
Location: Florida
Workplace: Remote
Employment Type: Full time
Job Function: Solutions Engineering & Sales Engineering
Seniority: Manager level

Key Responsibilities

  • •Lead, coach, and develop a team of clinical reviewers supporting appeals and utilization management activities.
  • •Serve as a subject matter expert for medical-necessity determinations and appeals management, providing training and guidance.
  • •Monitor and evaluate performance, productivity, quality, and compliance with service-level agreements and established standards.
  • •Oversee case assignment, ensure timely and accurate processing of member/provider appeals, and maintain compliant appeal documentation.
  • •Track and report quality/operational metrics, identify improvement opportunities, and partner with stakeholders to strengthen clinical appeals processes.

Pay and Benefits

Salary: USD 93,600 annually
Perks:Health InsuranceDentalVision401kPaid TimeLife InsuranceDisability Coverage

Key Requirements

  • •5+ years of experience in appeals management, utilization management, or clinical review operations.
  • •1 year of leadership experience in a supervisory, managerial, or team lead role.
  • •Strong knowledge of utilization management and appeals processes, including Medicaid regulations and NCQA standards.
  • •Demonstrated expertise reviewing medical records and clinical documentation, with strong analytical decision-making skills.
  • •Active Registered Nurse (RN) license and Florida-required RN licensure/Compact RN licensure (not encumbered), plus availability for U.S. daytime business hours.
Experience:5+ yearsHealthcareManaged careHealth planUtilization managementAppeals managementMedicaidBPO
Skills:LeadershipCoachingAnalytical thinkingCommunicationIndependent work
Licenses:Registered Nurse (RN) license
Tech Stack:2-Factor Authentication

Company Brief

NTT
Dimension Data, operating under NTT Ltd, provides managed IT services, cloud and data center solutions, networking, cybersecurity, and digital transformation services to enterprise customers worldwide.
Industry: Professional Services
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Established Company
Valuation: Public Company (Market Cap in USD)
Headquarters: London, United Kingdom
Founded: 1983
WebsiteLinkedIn