THE ROLE:

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

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

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.

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.

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

4. 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.

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

SOURCING STRATEGY & TARGET PROFILES:
- Priority Candidate Backgrounds:
• Healthcare BPO operations leaders
• U.S. healthcare operations executives
• Utilization Management leaders
• Care Management and Disease Management leaders
• Clinical Operations Directors
• Healthcare Shared Services and Captive Operations Leaders

Suggested Target Job Titles:
• Senior Director of Healthcare Operations
• Vice President of Healthcare Operations
• Director of Operations – Healthcare
• AVP of Operations – Healthcare
• Director of Clinical Operations
• Director of Utilization Management
• Head of Utilization Management
• Director of Care Management
• Senior Operations Director – Healthcare


***Recruitment Process***
CV Validation-Phone Screening (Gratitude)-TA Interview-Three interview rounds, with the final round conducted face-to-face at EDSA or McKinley.


RECRUITER SCREENING PRIORITIES

Before endorsing a candidate, ensure the following are assessed and documented:
1. Total years of Healthcare Operations experience.
2. Total years of senior leadership experience.
3. Number of FTEs currently or previously managed.
4. Specific healthcare domains handled (UM, Care Management, Disease Management).
5. Recent hands-on experience in UM, Care Management, and/or Disease Management.
6. USRN license status, if applicable.
7. Experience in Prior Authorization, Clinical Review, and Medical Necessity.
8. Familiarity with MCG/Milliman, InterQual, CMS, and HIPAA.
9. Medical Coding exposure (ICD-10, CPT, HCC), if applicable.
10. Client management, P&L, budgeting, and financial accountability experience.
11. Current or last drawn salary and expected salary.
12. LinkedIn Profile:
13. Availability to start ASAP.
14. Willingness to work onsite in MOA on a US Day Shift / Philippine night shift.
15. Complete employment history, including verification of hiring restrictions.