Senior Director / Vice President of Operations – Healthcare BPO

Program: Healthcare | Work Setup: 100% Onsite | Shift: US Day Shift

Salary Range: ₱250,000 – ₱350,000

compensation will depend on the candidate’s current or previous salary, experience, and qualifications. Salary expectations must remain reasonable and aligned with the approved budget._

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:

    - 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

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

- Recent, hands-on Utilization Management experience

- Experience in Prior Authorization, Clinical Review, Medical Necessity, and related UM workflows

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

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

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