Program: Healthcare

Work Setup: 100% Onsite

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

Salary Range: ₱250,000–₱350,000

Target Start Date: ASAP

Job Overview

We are seeking an experienced Senior Director / Vice President of Healthcare Operations to provide strategic leadership and operational oversight across healthcare programs. The ideal candidate will have extensive healthcare domain experience, preferably with a background in Utilization Management (UM), clinical operations, and large-scale healthcare BPO leadership.

Candidates with an active U.S. Registered Nurse (USRN) license and recent, hands-on Utilization Management experience will receive priority consideration.

Key Responsibilities

- Provide strategic direction and operational leadership for healthcare programs.

- Oversee large-scale healthcare operations, ensuring operational efficiency and service delivery excellence.

- Lead and manage Utilization Management (UM), Clinical Review, Prior Authorization, and Medical Necessity processes.

- Drive operational performance through effective workforce management, quality assurance, and process improvements.

- Ensure compliance with healthcare regulations, operational standards, and client requirements.

- Lead, develop, and mentor senior management teams.

- Identify operational gaps and implement strategies to improve productivity, quality, and overall performance.

- Manage stakeholder relationships and support business growth initiatives.

Minimum Qualifications

- Extensive leadership experience in healthcare operations, healthcare BPO, or clinical operations.

- Direct exposure to healthcare processes and operations is mandatory.

- Proven experience managing large-scale healthcare programs or operational teams.

- Strong understanding of healthcare workflows, particularly Utilization Management, Prior Authorization, Clinical Review, or Medical Necessity.

- Demonstrated ability to lead senior-level teams and drive operational excellence.

- Excellent strategic planning, communication, and stakeholder management skills.

Highly Preferred Qualifications

- Active U.S. Registered Nurse (USRN) license.

- Recent, hands-on Utilization Management experience.

- Previous experience in Prior Authorization, Clinical Review, Medical Necessity, Care Management, or Disease Management.

- Combination of clinical healthcare experience and large-scale healthcare BPO operational leadership.

Additional Advantages

- Exposure to Medical Coding operations, including ICD-10, CPT, and HCC.

- Lean Six Sigma, Process Excellence, or other continuous improvement certifications.

- Experience managing multiple healthcare programs or accounts.

- Additional clinical or healthcare-related certifications.

Target Candidate Profiles

We welcome applications from professionals with backgrounds in:

- Senior Director of Healthcare Operations

- Vice President of Healthcare Operations

- Director of Operations – Healthcare

- AVP of Operations – Healthcare

- Director of Clinical Operations

- Director / Head of Utilization Management

- Director of Care Management

- Senior Operations Director – Healthcare

Important Hiring Note: General BPO leadership experience without direct healthcare domain exposure will not meet the requirements for this position.