• Apply clinical judgment and evidence-based criteria to review inpatient and outpatient services. • Collaborate with providers and authorize care while maintaining accurate documentation. • Participate in occasional on-call rotations, including some weekends and holidays. • Conduct clinical reviews via phone and collaborate with healthcare providers to gather necessary information. • Navigate multiple computer systems efficiently while maintaining documentation accuracy. • Flexibly provide coverage for other Utilization Management Nurses as needed.

• Apply critical thinking and evidence-based clinical criteria to evaluate outpatient and inpatient services requiring precertification and concurrent review. • Conduct clinical reviews via phone and electronic documentation, collaborating with healthcare providers to gather necessary information. • Use established guidelines to authorize services or escalate to Medical Directors as needed. • Navigate multiple computer systems efficiently while maintaining accurate documentation. • Thrive in a fast-paced, high-volume environment with strong organizational, multitasking, and prioritization skills. • Ensure continuity of care and operational support as a Utilization Management (UM) Nurse across various UM specialty teams as needed. • Participate in occasional on-call rotations, including some weekends and holidays, per URAC and client requirements.

Role Description As a Consultant within our Digital Services organization, you will leverage your call center BPO expertise to drive the optimal utilization of digital solutions across customer service operations. You will work closely with cross-functional teams and stakeholders to assess current operations and technical stack utilization, then formulate recommendations to improve processes and systems. Primary Job Responsibilities - Translate KPIs into ROI and business value. - Quantify business value and ROI for CS solutions such as CCaaS/AI by linking technology capabilities to measurable outcomes such as AHT reduction, SLA improvement, cost savings, and revenue impact. - Document customer journeys across all touchpoints (live agent chat, phone calls, email, chatbot, voicebot, social media, etc.). - Review existing tools and systems, identifying gaps and proposing technological solutions to address operational issues. - Interview agents, site leader and QA to understand their view on processes and system interaction. - Analyze operating KPIs and translate insights into quantified business impact and ROI opportunities. - Manage stakeholder engagement, ensuring buy-in and active participation throughout the project lifecycle. - Design and run Design Workshops to improve processes, communications and reduce friction in those journeys. - Formalize and document “as is” and “to be” customer journeys aligned with newly implemented technologies such as voicebots, chatbots, conversational SMS, chat solutions, CRM, Knowledge Management, CCaaS, etc. - Define business rules to optimize customer interactions and enhance operational efficiency. - Develop and implement digital strategies where needed. - Co-design and develop reporting frameworks in collaboration with the client to track performance and value realization. - Support CCaaS project delivery activities as needed, including deliverables creation, testing and go live support. - Work closely with Professional Services, Program Managers, Customer Success, Solutions, Account Management, Business Development and Operations teams to ensure that business requirements are met in the solution design. - Ensure clear communication of project outputs and facilitate the integration of business requirements into the implementation. - Lead post-implementation reviews to evaluate the impact of the new tools and services, ensuring they are meeting performance KPIs and driving operational success. - Analyze post-implementation data, work with Continuous Improvement (CI) teams to assess results, and recommend adjustments or optimizations. Qualifications - Experience in BPO management, customer service operations, or continuous improvement with a strong understanding of performance levers such as contact flow distribution, workforce optimization, and training. - Experience with CCaaS platforms and understanding of contact center operations. - Exposure to AI-driven CX solutions (e.g. chatbots, voicebots, analytics) and their application in customer service environments. - Strong ability to quantify business impact (ROI, cost savings, efficiency gains) from CX and technology initiatives. - A passion for learning and improving how things are done. - Great communication skills—you’ll work with lots of different teams and customers, so being able to share ideas clearly is key. - Experience in Customer Journey mapping and workshop facilitation is a plus. - Fluency in English; other languages are a bonus. - Previous experience in operational management of customer service operations. - Previous positions held; Senior Ops Managers, Customer Success, Continuous Improvement, Professional Services, Consultant. Benefits - Competitive compensation package. - Excellent learning and development opportunities (AI, technology, evolving BPO landscape). - Growth opportunities within an expanding team. - Fully remote working available.

Role Description As a Consultant within our Digital Services organization, you will leverage your call center BPO expertise to drive the optimal utilization of digital solutions across customer service operations. You will work closely with cross-functional teams and stakeholders to assess current operations and technical stack utilization, then formulate recommendations to improve processes and systems. Primary Job Responsibilities - Translate KPIs into ROI and business value. - Quantify business value and ROI for CS solutions such as CCaaS/AI by linking technology capabilities to measurable outcomes such as AHT reduction, SLA improvement, cost savings, and revenue impact. - Engage the Project from a Business Perspective: - Document customer journeys across all touchpoints (live agent chat, phone calls, email, chatbot, voicebot, social media, etc.). - Review existing tools and systems, identifying gaps and proposing technological solutions to address operational issues. - Interview agents, site leader and QA to understand their view on processes and system interaction. - Analyze operating KPIs and translate insights into quantified business impact and ROI opportunities. - Manage stakeholder engagement, ensuring buy-in and active participation throughout the project lifecycle. - Design and run Design Workshops to improve processes, communications and reduce friction in those journeys. - Manage the Implementation Process: - Formalize and document “as is” and “to be” customer journeys aligned with newly implemented technologies such as voicebots, chatbots, conversational SMS, chat solutions, CRM, Knowledge Management, CCaaS, etc. - Define business rules to optimize customer interactions and enhance operational efficiency. - Develop and implement digital strategies where needed. - Co-design and develop reporting frameworks in collaboration with the client to track performance and value realization. - Support CCaaS project delivery activities as needed, including deliverables creation, testing and go live support. - Collaborate with Professional Services Teams: - Work closely with Professional Services, Program Managers, Customer Success, Solutions, Account Management, Business Development and Operations teams to ensure that business requirements are met in the solution design. - Ensure clear communication of project outputs and facilitate the integration of business requirements into the implementation. - Post-Implementation Support & Analysis: - Lead post-implementation reviews to evaluate the impact of the new tools and services, ensuring they are meeting performance KPIs and driving operational success. - Analyze post-implementation data, work with Continuous Improvement (CI) teams to assess results, and recommend adjustments or optimizations. Qualifications - Experience in BPO management, customer service operations, or continuous improvement with a strong understanding of performance levers such as contact flow distribution, workforce optimization, and training. - Experience with CCaaS platforms and understanding of contact center operations. - Exposure to AI-driven CX solutions (e.g. chatbots, voicebots, analytics) and their application in customer service environments. - Strong ability to quantify business impact (ROI, cost savings, efficiency gains) from CX and technology initiatives. - A passion for learning and improving how things are done. - Great communication skills—you’ll work with lots of different teams and customers, so being able to share ideas clearly is key. - Experience in Customer Journey mapping and workshop facilitation is a plus. - Fluency in English; other languages are a bonus. - Previous experience in operational management of customer service operations. - Previous positions held; Senior Ops Managers, Customer Success, Continuous Improvement, Professional Services, Consultant. Benefits - Competitive compensation package. - Excellent learning and development opportunities (AI, technology, evolving BPO landscape). - Growth opportunities within an expanding team. - Fully remote working available.