• Lead and manage large-scale healthcare operations, ensuring achievement of KPIs, SLAs, productivity, quality, and compliance targets.

• Oversee Utilization Management, Care Management, and Disease Management operations.

• Manage Prior Authorization, Clinical Reviews, Medical Necessity, Appeals, and Grievance workflows.

• Lead senior management teams, including Directors, Senior Managers, and Operations Managers.

• Manage executive client relationships, governance meetings, and Quarterly Business Reviews (QBRs).

• Drive operational efficiency, process improvements, and business transformation initiatives.

• Oversee budgeting, forecasting, cost management, revenue, and profit margins.

• Ensure compliance with HIPAA, PHI, CMS guidelines, and other applicable US healthcare regulations.

• Drive employee engagement, leadership development, succession planning, and retention.

• Partner with Quality, Compliance, Solutions, Transitions, and Sales teams to support business growth.

Qualifications & Requirements

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

• Master's degree or MBA is preferred.

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

• Minimum 5+ years in senior leadership positions such as Director, Senior Director, AVP, or VP.

• Proven experience managing large-scale operations with 500+ FTEs.

• Recent hands-on experience in Utilization Management, Care Management, or Disease Management.

• Strong knowledge of US healthcare processes, clinical workflows, and medical terminology.

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

• Strong experience in client management, P&L management, budgeting, forecasting, and operational performance.

• Excellent strategic leadership, stakeholder management, and decision-making skills.

Highly Preferred

• Active US Registered Nurse (USRN) license.

• Recent hands-on Utilization Management experience.

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

• Exposure to Medical Coding (ICD-10, CPT, HCC).

• Lean Six Sigma or Process Excellence certification.

Important: General BPO leadership experience without direct healthcare domain expertise will not be sufficient. Candidates with clinical healthcare knowledge combined with large-scale healthcare BPO leadership will be prioritized.

Skills