Role Overview:
Lead a 500–700 FTE Healthcare BPO operation, overseeing Utilization Management (UM), Care Management, and Disease Management while ensuring operational efficiency, client satisfaction, compliance, and profitability.

Key Requirements:

• 10+ years of Healthcare Operations experience.
• 5+ years in senior leadership.
• Experience managing 500+ FTEs.
• Hands-on experience in UM, Care Management, or Disease Management.
• Strong knowledge of U.S. healthcare processes, HIPAA, CMS, MCG/Milliman, and InterQual.
• Experience in client management, P&L, budgeting, and operational strategy.
• Bachelor's degree required; MBA/Master's preferred.

Top Priority: Active USRN license with recent hands-on Utilization Management experience.

Target Companies:
Optum, EXL, HGS, Sagility, Shearwater Health, UnitedHealthcare, Aetna/CVS, Cigna, Humana, Centene, Molina Healthcare, and Blue Cross Blue Shield.

Target Positions:
VP/Senior Director of Healthcare Operations, Director of Operations, Director of Clinical Operations, Director of Utilization Management, and Director of Care Management.

Hiring Restrictions:
Former employees of Teleperformance, PSG Global, Majorel, and Aegis are strictly ineligible for rehire.

Work Arrangement:
Onsite in MOA, Philippine night shift.

Recruitment Process:
CV Validation → Phone Screening → TA Interview → Three Interview Rounds (final face-to-face at EDSA/McKinley).

Recruiter Screening:
Confirm healthcare experience, leadership tenure, FTEs managed, clinical domain expertise, USRN status, salary expectations, LinkedIn profile, availability, onsite flexibility, and complete employment history.

Sourcing Priority: Candidates with strong healthcare BPO leadership, recent hands-on UM experience, and the ability to manage large-scale operations.