Location: MOA, Pasay City, Philippines

Work Setup: 100% Work From Office (WFO)

Shift Schedule: US Day Shift (Night Shift – Philippine Time)

Salary Range: PHP 250,000 – PHP 350,000 per month

Headcount: 1

Target Start Date: ASAP

Employment Type: Full-Time

Job Overview

We are looking for an experienced Senior Director / Vice President of Healthcare Operations to lead and manage large-scale Healthcare BPO operations with a strong focus on Utilization Management (UM), Care Management, and Disease Management.

The role will have end-to-end operational responsibility for an organization of approximately 500–700 FTEs, ensuring operational excellence, client satisfaction, regulatory compliance, financial performance, and effective leadership.

The ideal candidate must have extensive healthcare BPO leadership experience, strong knowledge of US healthcare processes, and a proven track record of managing large-scale operations and senior leadership teams.

Candidates with an active USRN license and recent hands-on Utilization Management experience will be highly preferred.

Key Responsibilities

1. Strategic & Operational Leadership

Provide strategic direction and overall leadership for healthcare operations.

Ensure achievement of contractual KPIs, SLAs, quality, productivity, and compliance targets.

Translate business and client objectives into operational strategies and measurable results.

Lead multi-layered leadership teams, including Directors, Senior Managers, and Operations Managers.

Ensure stable, efficient, and scalable operations across healthcare programs.

2. Healthcare Operations Management

Oversee Utilization Management, Care Management, and Disease Management operations.

Manage and optimize healthcare workflows, including:

Prior Authorization

Prospective, Concurrent, and Retrospective Reviews

Appeals and Grievance Operations

Clinical Review and Medical Necessity processes

Ensure standardized workflows, quality controls, productivity benchmarks, and turnaround time compliance.

Maintain compliance with US healthcare requirements and clinical operational standards.

3. Client & Stakeholder Management

Serve as the executive point of contact for healthcare clients and senior stakeholders.

Lead weekly and monthly business reviews and Quarterly Business Reviews (QBRs).

Build and maintain strong client relationships.

Identify operational risks and implement performance improvement plans.

Collaborate with Sales, Solutions, and Transitions teams on new launches and business expansions.

4. Financial & Business Management

Manage operational budgets, costs, and profitability.

Drive margin improvement, staffing efficiency, and productivity optimization.

Monitor attrition, resource utilization, and operational expenses.

Maintain accountability for revenue, margins, and overall P&L performance.

Ensure cost efficiency without compromising service quality or compliance.

5. Compliance & Risk Management

Ensure adherence to healthcare regulatory requirements, privacy standards, and HIPAA-aligned controls.

Maintain audit readiness and strong internal governance.

Partner with Quality and Compliance teams to address audit findings and implement corrective actions.

Ensure the protection and confidentiality of Protected Health Information (PHI).

6. People Leadership & Development

Lead and manage a large organization of approximately 500–700 FTEs.

Mentor and develop senior leadership teams.

Establish succession planning and leadership development initiatives.

Drive employee engagement, retention, accountability, and organizational performance.

7. Continuous Improvement & Transformation

Identify opportunities to improve operational efficiency, quality, and scalability.

Use operational analytics and performance data to support strategic decisions.

Drive automation, digitization, and process transformation initiatives.

Mandatory Qualifications

Minimum 10+ years of Healthcare Operations experience in a BPO, shared services, or captive environment.

Minimum 5+ years of senior leadership experience at Director, Senior Director, VP, AVP, or equivalent level.

Proven experience managing 500+ FTEs in complex, multi-layered operations.

Recent, hands-on experience in at least one or more of the following:

Utilization Management (UM) – Preferred

Care Management

Disease Management

Strong understanding of US healthcare processes, clinical workflows, and medical terminology.

Knowledge of MCG/Milliman, InterQual, CMS guidelines, and HIPAA.

Proven experience in executive client management and operational governance.

Strong background in performance management, leadership development, and operational analytics.

Experience in forecasting, budgeting, revenue management, and margin performance.

Excellent communication, stakeholder management, and strategic decision-making skills.

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

Preferred: Master's degree or MBA.

Highly Preferred Profile: USRN + Utilization Management

Active US Registered Nurse (USRN) license is highly preferred.

Recent, hands-on Utilization Management experience is strongly preferred.

Experience in Prior Authorization, Clinical Review, and Medical Necessity workflows.

Candidates combining clinical healthcare knowledge with large-scale healthcare BPO operational leadership will receive priority.

Important: General BPO leadership experience without direct healthcare domain exposure will not be sufficient for this position.

Good to Have

Medical Coding exposure, including ICD-10, CPT, and HCC.

Lean Six Sigma or Process Excellence certifications.

Experience managing multiple healthcare programs or accounts.

Additional clinical or healthcare-related certifications.

Medical Coding experience is an added advantage and is not mandatory.

Compensation

PHP 250,000 – PHP 350,000 per month

Compensation will depend on the candidate's current or previous salary, experience, qualifications, and alignment with the client's approved budget. Salary expectations should be reasonable and within the approved range.

Important Hiring Restrictions

Candidates with employment history at the following organizations are strictly not eligible for rehire, either directly or through a third party:

Teleperformance (TP)

PSG Global Solutions

Majorel

Aegis

All candidates' complete employment histories will be reviewed before proceeding with validation or endorsement.

Recruitment Process

CV Validation

Phone Screening (Gratitude)

TA Interview

Three rounds of interviews

Final interview – Face-to-face at EDSA or McKinley

Interested Candidates

Candidates with strong healthcare operations leadership experience, hands-on exposure to US healthcare processes, and the ability to lead large-scale operations are encouraged to apply.

USRN candidates with recent Utilization Management experience are the top priority. However, exceptional non-USRN candidates with strong healthcare operations leadership and recent UM, Care Management, or Disease Management experience will also be considered