JOB DESCRIPTION: SENIOR DIRECTOR / VICE PRESIDENT OF OPERATIONS

JOB DETAILS

- Program: Healthcare

- Location: MOA, Pasay City

- Work Setup: 100% Onsite

- Shift: US Day Shift (Philippine Night Shift)

- Headcount: 1

- Target Start Date: ASAP

ROLE OVERVIEW

We are seeking an experienced 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 role will oversee a 500–700 FTE organization, ensuring operational excellence, client satisfaction, regulatory compliance, financial performance, and effective people management.

Highly Preferred: Active USRN candidates with recent, hands-on Utilization Management experience and proven large-scale healthcare BPO leadership.

KEY RESPONSIBILITIES

1. Strategic & Operational Leadership

- Lead healthcare operations and ensure achievement of KPIs, SLAs, quality, productivity, and compliance targets.

- Develop operational strategies aligned with business and client objectives.

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

- Ensure stable, efficient, and scalable operations.

2. Healthcare Operations

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

- Manage Prior Authorization, Prospective, Concurrent and Retrospective Reviews, Appeals and Grievances, Clinical Reviews, and Medical Necessity processes.

- Ensure standardized workflows, productivity, quality controls, and turnaround times.

- Maintain compliance with U.S. healthcare requirements.

3. Client & Stakeholder Management

- Serve as executive sponsor for healthcare clients.

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

- Manage operational risks and performance improvement plans.

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

4. Financial & Commercial Management

- Manage operational budgets, costs, and margins.

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

- Maintain P&L accountability and cost-to-serve discipline.

5. Compliance & Governance

- Ensure adherence to healthcare regulations, PHI protection, and HIPAA-aligned controls.

- Maintain audit readiness and internal controls.

- Address audit findings and implement corrective actions with Quality and Compliance teams.

6. People Leadership

- Lead a 500–700 FTE organization.

- Mentor Directors, Senior Managers, and Operations Managers.

- Develop succession plans and leadership capabilities.

- Drive employee engagement, retention, and accountability.

7. Continuous Improvement

- Implement process improvements and operational transformation initiatives.

- Use analytics and performance data for decision-making.

- Support automation, digitization, efficiency, and scalability.

QUALIFICATIONS & REQUIREMENTS

Mandatory:

- 10+ years of Healthcare Operations experience in BPO, shared services, or captive environments.

- 5+ years in senior leadership positions (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 of the following:

  - Utilization Management (preferred)

  - Care Management

  - Disease Management

- Strong knowledge of U.S. healthcare processes, clinical workflows, and medical terminology.

- Familiarity with MCG/Milliman, InterQual, CMS guidelines, and HIPAA.

- Experience in executive client management, performance governance, and operational optimization.

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

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

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

- Bachelor's degree 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

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

- Recent, hands-on UM experience.

- Combined clinical healthcare knowledge and large-scale Healthcare BPO leadership.

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

Important: General BPO leadership experience without direct healthcare domain exposure is insufficient.

ADDED ADVANTAGE (NICE TO HAVE)

- Medical Coding exposure: 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 is an advantage, not a mandatory requirement.

SOURCING STRATEGY

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

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 / Head of Utilization Management

- Director of Care Management

- Senior Operations Director – Healthcare

Target Organizations:

Healthcare BPO providers, healthcare outsourcing companies, U.S. health insurance organizations, health plans, and healthcare shared services/captive operations.

RECRUITER SCREENING CHECKLIST

Before endorsing a candidate, assess and document:

1. Total years of Healthcare Operations experience.

2. Total years of senior leadership experience.

3. Number of FTEs currently or previously managed.

4. Healthcare domains handled: UM, Care Management, and Disease Management.

5. Recent hands-on experience in these healthcare domains.

6. USRN license status, if applicable.

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

8. Knowledge of 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.

11. Current or last drawn salary and expected salary.

12. LinkedIn profile.

13. Availability to start ASAP.

14. Willingness to work 100% onsite in MOA on a Philippine night shift.

15. Complete employment history and verification of hiring restrictions.

CV ENDORSEMENT GUIDELINES

Prioritize candidates with strong, hands-on healthcare experience.

Ensure their latest CV clearly highlights:

- Relevant healthcare projects and specific account exposure.

- Practical application of required clinical and operational skills.

- Direct UM, Care Management, and Disease Management experience.

- Prior Authorization, Clinical Review, and Medical Necessity exposure.

- Large-scale operations leadership and FTE management.

- Executive client management and financial accountability.

- Relevant certifications and active USRN license, if applicable.

TOP PRIORITY: Candidates combining an active USRN license, recent hands-on Utilization Management experience, and proven leadership of large-scale Healthcare BPO operations.