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

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‎The successful candidate will provide end-to-end operational leadership for a 500–700 FTE organization, ensuring operational excellence, client satisfaction, regulatory compliance, financial performance, and effective people management.

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‎This critical leadership position requires deep, hands-on healthcare domain expertise combined with proven experience managing large-scale operations and senior leadership teams.

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‎USRN candidates with recent, hands-on Utilization Management experience are highly preferred. Candidates who combine clinical healthcare knowledge with strong BPO operational leadership will be given priority.

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‎KEY RESPONSIBILITIES

‎A. Strategic & Operational Leadership

‎Provide overall leadership and direction for healthcare operations, ensuring consistent achievement of contractual KPIs, SLAs, quality, productivity, and compliance standards.

‎Translate business and client objectives into operational strategies, execution plans, and measurable outcomes.

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

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

‎B. Healthcare Delivery – Core Focus

‎Oversee healthcare operations with direct experience in Utilization Management, Care Management, and Disease Management.

‎Ensure operational excellence across the following healthcare processes:

‎Prior Authorization workflows.

‎Prospective, Concurrent, and Retrospective Reviews.

‎Appeals and Grievance Operations, where applicable.

‎Clinical Review and Medical Necessity processes.

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

‎Drive operational efficiency while maintaining compliance with U.S. healthcare requirements.

‎C. Client & Stakeholder Management

‎Act as the executive sponsor for healthcare clients, building strong relationships with senior client stakeholders.

‎Lead client governance forums, including weekly and monthly business reviews and Quarterly Business Reviews (QBRs).

‎Proactively identify operational risks and implement performance improvement plans.

‎Partner with Solutions, Transitions, and Sales teams on new program launches, expansions, and business initiatives.

‎D. Financial & Commercial Accountability

‎Own operational cost management, budgeting, and margin improvement initiatives.

‎Drive staffing efficiency, attrition management, productivity optimization, and process standardization.

‎Maintain a strong P&L mindset across leadership teams.

‎Ensure cost-to-serve discipline without compromising service quality and compliance.

‎E. Compliance, Risk & Governance

‎Ensure strict adherence to healthcare regulatory, privacy, and data protection requirements, including PHI and HIPAA-aligned controls.

‎Maintain audit readiness and strong internal controls for healthcare and UM operations.

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

‎F. People Leadership & Talent Development

‎Lead and inspire a 500–700 FTE organization.

‎Develop and mentor senior leadership teams, including Directors, Senior Managers, and Operations Managers.

‎Establish succession plans and strengthen leadership capabilities.

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

‎G. Continuous Improvement & Transformation

‎Identify and implement process improvements to drive efficiency, quality, and scalability.

‎Leverage operational data, analytics, and performance insights for fact-based decision-making.

‎Support automation, digitization, and transformation initiatives aligned with healthcare operations.

‎QUALIFICATIONS & REQUIREMENTS

‎A. Mandatory Qualifications

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

‎5+ years of experience in senior leadership roles (Director, Senior Director, or equivalent and above).

‎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 U.S. healthcare processes, clinical workflows, and medical terminology.

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

‎Proven experience in executive client management, performance governance, and operational optimization.

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

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

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

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

‎Master's degree or MBA is preferred but not mandatory.

‎B. Highly Preferred: USRN + Utilization Management Experience

‎Candidates with an active U.S. Registered Nurse (USRN) license are highly preferred.

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

‎Candidates with both clinical healthcare experience and large-scale healthcare BPO operational leadership will be prioritized.

‎Experience in Prior Authorization, Clinical Review, Medical Necessity, and related UM workflows is a strong advantage.

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

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‎ADDED ADVANTAGE (NICE TO HAVE)

‎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.

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‎Note: Medical Coding experience is an added advantage, not a mandatory requirement.