Job Description: Clinical Operations Assistant Manager

Program: Healthcare – Hybrid Voice and Back-Office Operations
Location: Vertis North, Quezon City, Philippines
Work Setup: 100% Onsite
Shift: US Day Shift
Salary: Open, based on current/last-drawn salary, experience, qualifications, and client budget
Target Start Date: On or before December 15
Headcount: 1

Role Overview

We are seeking an experienced Clinical Operations Assistant Manager to lead a high-performing clinical operations team supporting a major US managed care program. The successful candidate will oversee daily operational performance, clinical quality, regulatory compliance, and team development across hybrid voice and back-office healthcare operations.

The ideal candidate will have a strong background in Utilization Review (UR), Utilization Management (UM), and healthcare BPO leadership, along with active Philippine RN and unrestricted USRN licenses.

Key Responsibilities

1. Clinical Operations Management

• Oversee daily clinical operations to ensure service levels, turnaround times, productivity, quality, and documentation targets are consistently achieved.

• Monitor operational KPIs and SLAs, identify performance gaps, and implement recovery plans.

• Conduct team huddles, interval monitoring, root cause analysis (RCA), and performance reviews.

• Ensure operational workflows align with client requirements and established clinical protocols.

2. Clinical Quality and Compliance

• Maintain strict compliance with HIPAA, Protected Health Information (PHI) requirements, and applicable healthcare policies.

• Lead clinical quality assurance activities, including audits, calibrations, documentation reviews, and coaching.

• Ensure clinical reviews and operational decisions meet established quality standards.

• Support compliance with relevant CMS requirements and applicable URAC/NCQA standards.

• Identify quality trends and implement corrective and preventive actions.

3. Team Leadership and Development

• Lead, coach, and mentor registered nurses (RNs), clinical associates, and team leaders.

• Monitor individual and team performance and establish improvement plans where necessary.

• Manage competency assessments, preceptorship programs, and continuing education (CE) tracking.

• Monitor professional license validity and ensure compliance with credentialing requirements.

• Promote continuous learning, accountability, and a high-performance team culture.

4. Utilization Review and Managed Care Operations

• Oversee Utilization Review (UR) and Utilization Management (UM) workflows and operational delivery.

• Ensure clinical review processes follow applicable protocols, payer requirements, and service-level timelines.

• Support operations related to Case Management (CM), Health Risk Assessment (HRA), triage, and other managed care activities as applicable.

• Translate clinical protocol updates into practical workflows, job aids, and training materials.

• Identify opportunities to improve clinical review accuracy, turnaround time, and operational efficiency.

5. Stakeholder Collaboration

• Partner with Workforce Management (WFM), Talent Acquisition (TA), Quality Assurance (QA), training teams, and client stakeholders.

• Communicate operational performance, risks, staffing requirements, and improvement initiatives.

• Support onboarding, training, and competency development for clinical team members.

• Drive process improvement initiatives to enhance service delivery and client satisfaction.

Required Qualifications

• Bachelor of Science in Nursing (BSN).

• Active Philippine Registered Nurse (PHRN) license.

• Active, unrestricted US Registered Nurse (USRN) license with NCLEX passed.

• At least 5 years of clinical and healthcare operations experience.

• At least 3 years of team leadership experience in healthcare BPO or shared services.

• Current experience managing Utilization Review (UR) or Utilization Management (UM) operations.

• Strong knowledge of US managed care, UM, Case Management, CMS requirements, and HIPAA.

• Demonstrated experience managing operational SLAs, KPIs, clinical quality, and productivity.

• Willingness to work onsite at Vertis North, Quezon City, on a US day shift.

License requirement: Both nursing licenses must be active. Candidates whose licenses are nearing expiration must be willing to renew them.

Preferred Qualifications

• Experience in Utilization Review, Utilization Management, Case Management, Health Risk Assessment, triage, or payer operations.

• Familiarity with URAC and NCQA standards.

• Experience in clinical training, education, competency development, or preceptorship.

• Strong analytical, problem-solving, communication, and stakeholder management skills.

Key Performance Indicators (KPIs)

• SLA and turnaround-time achievement

• Clinical quality and documentation accuracy

• Team productivity and operational efficiency

• Compliance with HIPAA, PHI, and clinical protocols

• Audit and calibration results

• Team performance, competency, and retention

• Continuous improvement and client satisfaction

Recruitment Process

1. Profile Validation

2. Profile Review

3. Talent Acquisition (TA) Interview

4. Hiring Manager (HM) Interview

5. Client Interview

Candidates must complete an on-the-spot clinical review writing assessment during the interview. They should be advised in advance to bring a laptop or desktop computer.

Important Hiring Restrictions

• Former Teleperformance (TP) employees are not eligible for rehire, directly or through a third party.

• Candidates previously employed by PSG Global, Majorel, or Aegis are also ineligible under the client's hiring restrictions.

Candidate Pre-Screening Questions

1. Educational Attainment: What is your highest educational qualification?

2. Clinical and Healthcare Operations Experience: How many years of relevant experience do you have?

3. Leadership Experience: How many years have you led teams in healthcare BPO or shared services?

4. UR/UM Background: Do you have experience in Utilization Review (UR) and Utilization Management (UM)? Please describe your current responsibilities.

5. Licenses: Do you hold active PHRN and unrestricted USRN licenses? When do they expire?

6. Training Experience: How many years of clinical training or education experience do you have?

7. Last-Drawn Salary: What was your most recent salary package?

8. Expected Salary: What is your expected salary package?

9. Employment Eligibility: Have you previously worked for Teleperformance, PSG Global, Majorel, or Aegis?

10. Work Arrangement: Are you willing to work onsite at Vertis North, Quezon City, on a US day shift?

11. Assessment Readiness: Can you complete the clinical review writing assessment using a laptop or desktop during the interview?

Ideal Candidate Profile

The ideal candidate is a licensed nursing professional with strong US managed care knowledge, current UR/UM operations experience, and proven healthcare BPO leadership capabilities. They should be able to balance clinical quality, regulatory compliance, operational performance, and team development in a fast-paced environment.