Hiring: BPO Senior Manager Company: NTT DATA North America Location: Tampa, FL Job Posted Time: 2026-09-11 12:15:43 Employment Type: Remote Target Skills & Keywords : AI, Accessibility, Clinical Documentation, Medicaid, R, Regulatory Compliance About the job Experience: •5 years of experience in appeals management, utilization management, or clinical review operations. •1 year of leadership experience in a supervisory, managerial, team lead Required Skills: •Lead, coach, and develop a team of Clinical Reviewers responsible for appeals and utilization management activities. •Serve as a subject matter expert (SME) and provide training, mentorship, and guidance on clinical review processes, medical necessity determinations, and appeals management. •Monitor and evaluate team performance, productivity, quality, and compliance with established standards and service-level agreements. •Allocate and manage case assignments to ensure balanced workloads and adherence to turnaround times. •Partner cross-functionally with customers and internal stakeholders to ensure operational standards and performance expectations are met. •Provide ongoing feedback, performance management, and development opportunities for team members. •Reviewing medical records and clinical documentation. •Evaluating applicable medical necessity criteria. Qualifications: •Strong knowledge of utilization management and appeals processes. •In-depth understanding of NCQA standards, Medicaid regulations, and medical necessity review requirements. •Demonstrated expertise in reviewing medical records and clinical documentation. •Strong analytical and critical-thinking skills with the ability to make sound decisions in complex situations. •Excellent written and verbal communication skills, including strong reading comprehension and documentation abilities. •Demonstrated capacity to work independently while effectively leading and influencing team performance. •Proficiency in performance tracking, reporting, and operational management. •Prior experience managing clinical appeals teams in a health plan, managed care organization, or healthcare BPO environment. •Must be available to work during U.S. daytime business hours. •May require flexibility based on operational and customer needs. Compensation: •Flexible work environment (work from home / hybrid options) Interested candidates, please apply directly through the job posting on company's career page or try via AI auto apply on this platform. Don't miss this opportunity to join a forward-thinking team!