JOB DESCRIPTION: CLINICAL OPERATIONS ASST. MANAGER (MANAGER)

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, and qualifications. Salary expectations should remain reasonable and aligned with the client’s budget.

Target Start Date: On or before December 15

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.

- Active, unrestricted USRN license (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 (UM), Case Management (CM), CMS, and HIPAA.

- Proven experience managing SLAs, KPIs, and clinical operational performance.

- Background in Utilization Review (UR)/Utilization Management (UM), with current experience managing UR operations.

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

- Familiarity with URAC/NCQA standards is an advantage.

- Training experience is preferred.

- Willing to work onsite on a US day shift.