Job Overview

We are looking for an experienced Clinical Operations Assistant Manager to lead a clinical operations team supporting a major US managed care program. This role is responsible for driving service excellence, clinical quality, operational performance, regulatory compliance, and team development in a fast-paced, metrics-driven healthcare environment.

The ideal candidate will have an active Philippine Registered Nurse (PHRN) license, an active and unrestricted US Registered Nurse (USRN) license, strong healthcare BPO leadership experience, and current experience managing Utilization Review (UR) operations.

Key Responsibilities

1. Clinical Operations and Performance Management

• Oversee daily clinical operations and ensure achievement of service-level agreements (SLAs), key performance indicators (KPIs), turnaround time, productivity, quality, and documentation targets.

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

• Identify operational gaps and implement corrective actions to improve service delivery.

• Ensure clinical workflows are efficient, consistent, and aligned with client requirements.

2. Clinical Quality and Compliance

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

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

• Monitor compliance with clinical protocols, documentation requirements, and operational policies.

• Support audit readiness and continuous improvement initiatives.

3. Team Leadership and Development

• Lead, coach, mentor, and develop Registered Nurses, clinical associates, and team leaders.

• Oversee competency development programs, preceptorship, continuing education (CE) tracking, and professional license validity.

• Identify performance and knowledge gaps and implement appropriate development plans.

• Foster accountability, collaboration, and continuous professional development within the team.

4. Stakeholder Collaboration and Process Improvement

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

• Translate clinical protocol updates into practical workflows, training materials, and operational guidance.

• Support implementation of process improvements to enhance clinical quality, productivity, and operational efficiency.

• Communicate performance trends, risks, and improvement initiatives to relevant stakeholders.

Qualifications and Requirements

• Bachelor of Science in Nursing (BSN) graduate.

• Active Philippine Registered Nurse (PHRN) license.

• Active and 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) operations, with a strong background in Utilization Review (UR) and Utilization Management (UM).

• Strong knowledge of US managed care, Case Management (CM), CMS, and HIPAA requirements.

• Proven experience managing SLAs, KPIs, clinical quality, and operational performance.

• Experience in UM, CM, Health Risk Assessment (HRA), triage, or payer operations is preferred.

• Familiarity with URAC and NCQA standards is an advantage.

• Clinical training or education experience is preferred.

• Strong leadership, analytical, communication, coaching, and stakeholder management skills.

• Willingness to work 100% onsite at Vertis North, Quezon City, on a US day shift.

License Requirement: Both Philippine RN and USRN licenses must be active. Candidates whose licenses are nearing expiration must be willing to renew them.

Required Interview Assessment

Candidates must complete an on-the-spot clinical review writing assessment during the interview. A laptop or desktop computer is required to complete the assessment. Please ensure you are prepared to use a computer during the interview.

Recruitment Process

1. Profile Validation

2. Profile Review

3. Talent Acquisition (TA) Interview

4. Hiring Manager (HM) Interview

5. Client Interview

Application Requirements

Submit an updated resume highlighting healthcare clinical operations experience, current UR/UM management responsibilities, leadership experience, active nursing licenses, and measurable operational achievements.

Important Employment Eligibility Requirement: Former employees of Teleperformance (TP), PSG Global Solutions, Majorel, and Aegis are not eligible for rehire, whether directly or through a third party.