Job title : Clinical Operations Assistant Manager | Healthcare Operations | USRN | Utilization Management

Work Location: Vertis North, Quezon City, Philippines
Work Setup: Onsite
Work Schedule: US Day Shift
Experience:  5-7yrs

Job Description : 

We are looking for an experienced Clinical Operations Assistant Manager to lead clinical operations for a US managed healthcare program. This role is ideal for a licensed Registered Nurse with strong healthcare operations leadership experience, expertise in Utilization Review (UR) and Utilization Management (UM), and a proven ability to drive clinical quality, operational performance, and team development.

Key Responsibilities : 

1. Clinical Operations Management: Oversee daily operations and monitor SLAs, KPIs, turnaround time, productivity, quality, and documentation accuracy.

2. Team Leadership and Performance: Conduct team huddles, monitor performance, perform root cause analysis (RCA), implement recovery plans, and coach team members.

3. Clinical Quality and Compliance: Ensure adherence to HIPAA, Protected Health Information (PHI) requirements, clinical protocols, and applicable quality standards.

4. Team Development: Mentor Registered Nurses, clinical associates, and team leaders; oversee competency assessments, preceptorship, continuing education, and license validity.

5. Process Improvement and Collaboration: Partner with Workforce Management, Talent Acquisition, Quality Assurance, and client stakeholders to improve workflows and implement clinical protocol updates.

Required Skills : 

• Clinical Operations and Healthcare Operations Management

• US Managed Care and Payer Operations

• Utilization Review (UR) and Utilization Management (UM)

• Healthcare BPO or Shared Services Team Leadership

• SLA/KPI Management, Clinical Quality Assurance, and Root Cause Analysis

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.

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

• Current experience managing Utilization Review operations.