PROGRAM: Healthcare – Hybrid Voice and Back-Office Operations

WORK LOCATION: Vertis North, Quezon City

WORK SETUP: Onsite

SHIFT SCHEDULE: US Day Shift

SALARY: Open, depending on the candidate's current or previous salary, experience
TARGET START DATE: On or before December 15, 2026



Job Overview

Lead a high-performing clinical operations team supporting a major US managed care program. Drive service excellence, clinical quality, and team development in a fast-paced, metrics-driven environment.


Key Responsibilities

Own daily SLA/KPI performance, including turnaround time, quality, productivity, and documentation


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


Ensure strict compliance with HIPAA and PHI requirements


Lead clinical quality assurance through audits, calibrations, coaching, and documentation reviews


Develop and mentor registered nurses (RNs), clinical associates, and team leaders


Manage competency programs, preceptorship, continuing education (CE) tracking, and license validity


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


Translate clinical protocol updates into practical workflows and training materials


Qualifications

Bachelor of Science in Nursing (BSN) graduate with an active Philippine RN license – required


Active, unrestricted USRN license (NCLEX passed) – required


At least 5 years of clinical and healthcare operations experience – required


At least 3 years of team leadership experience in healthcare BPO or shared services – required


Strong knowledge of US managed care, Utilization Management (UM), Case Management (CM), CMS, and HIPAA – required


Proven experience managing SLAs, KPIs, and clinical operational performance – required


Background in Utilization Review (UR)/Utilization Management (UM) with current experience managing UR operations – required


Preferred: Experience in UM, CM, Health Risk Assessment (HRA), triage, or payer operations


Preferred: Familiarity with URAC/NCQA standards


Preferred: Training experience


Willing to work onsite on a US day shift


USRN License Validity: The license must be active. Candidates whose licenses are nearing expiration must be willing to renew it.