Position Overview

We are looking for a strategic and results-oriented Senior Director / VP of Healthcare Operations to lead and manage large-scale healthcare BPO operations.

The position carries overall responsibility for a 500–700 FTE organization, overseeing operational delivery, client relationships, financial performance, regulatory compliance, and leadership effectiveness.

The successful candidate must have extensive experience in healthcare operations, particularly in Utilization Management, Care Management, or Disease Management, alongside a proven ability to lead senior management teams and drive business performance.

Core Responsibilities

• Operational Direction: Lead end-to-end healthcare operations, ensuring service delivery meets client expectations, contractual commitments, KPIs, SLAs, and quality standards.

• Healthcare Process Oversight: Manage operations covering Utilization Management, Care Management, Disease Management, Prior Authorization, Clinical Reviews, Medical Necessity, and related review processes.

• Executive Leadership: Direct and develop senior management teams, including Directors, Senior Managers, and Operations Managers, while overseeing a workforce of 500–700 FTEs.

• Client Relationship Management: Maintain executive-level client relationships, lead business governance meetings and QBRs, and ensure effective resolution of operational concerns.

• Business and Financial Performance: Manage budgets, operational costs, staffing efficiency, revenue, profitability, and margin improvement initiatives.

• Regulatory Compliance: Ensure adherence to HIPAA, PHI protection, CMS guidelines, and applicable U.S. healthcare standards.

• Performance Improvement: Identify operational gaps, implement corrective actions, and improve productivity, quality, turnaround times, and overall service efficiency.

• Organizational Development: Strengthen leadership capabilities, succession planning, employee engagement, retention, and accountability.

• Business Transformation: Support automation, digitization, process standardization, and continuous improvement initiatives.

Required Experience and Competencies

• 10+ years of healthcare operations experience within a BPO, shared services, or captive environment.

• At least 5 years in senior leadership positions at Director level or higher.

• Demonstrated ability to manage large-scale operations with 500+ FTEs.

• Recent hands-on experience in Utilization Management, Care Management, or Disease Management.

• Strong knowledge of U.S. healthcare operations, clinical workflows, and medical terminology.

• Familiarity with MCG/Milliman, InterQual, CMS guidelines, and HIPAA.

• Extensive experience in client governance, operational strategy, performance management, and financial accountability.

• Proven expertise in budgeting, forecasting, cost optimization, and P&L management.

• Strong executive communication, stakeholder engagement, and decision-making skills.

• Bachelor's degree in Nursing, Healthcare Administration, Business Administration, or a related field.

Preferred Candidate Profile

• Active USRN license.

• Recent, hands-on Utilization Management experience.

• Clinical background combined with extensive healthcare BPO leadership experience.

• Experience in Prior Authorization, Clinical Review, and Medical Necessity operations.

• Master's degree or MBA.

Additional Qualifications

• Knowledge of Medical Coding, including ICD-10, CPT, and HCC.

• Lean Six Sigma or Process Excellence certification.

• Experience managing multiple healthcare accounts or programs.

• Additional clinical or healthcare-related certifications.

Critical Requirement: Candidates must have direct healthcare operations experience. General BPO leadership experience without substantial healthcare domain exposure will not be considered sufficient for this position.