Job Overview
We are seeking a visionary and seasoned Senior Director / Vice President of Operations to lead our large-scale healthcare BPO organization in MOA, Pasay City. In this executive leadership role, you will provide end-to-end strategic and operational direction for a 500–700 FTE enterprise, with a specialized focus on Utilization Management (UM), Care Management, and Disease Management. You will act as the executive sponsor for US healthcare clients, ensuring flawless adherence to clinical workflows, regulatory and HIPAA compliance, financial profitability, and the continuous development of our senior leadership teams. (Note: Candidates with an active USRN license and hands-on Utilization Management experience will be given top priority).

Job Details

• Program / Domain: Healthcare Operations (Utilization Management, Care Management, Disease Management)

• Work Setup: 100% Onsite in MOA, Pasay City

• Work Shift: US Day Shift (Night Shift – Philippine Time)

• Salary Range: ₱250,000 – ₱350,000 (Compensation depends on current/previous salary, experience, and qualifications)

• Target Start Date: ASAP

Job Requirements

• Industry Experience: Minimum of 10+ years of Healthcare Operations experience within a BPO, shared services, or captive environment.

• Executive Leadership Tenure: At least 5+ years in senior leadership roles (Director, Senior Director, or equivalent and above), managing organizations of 500+ FTEs in complex, multi-layered operations.

• Core Healthcare Domain Expertise: Recent, hands-on operational background in at least one of the following: Utilization Management (highly preferred), Care Management, or Disease Management.

• Process & Clinical Knowledge: Deep understanding of U.S. healthcare processes, clinical workflows, medical terminology, and specific guidelines such as MCG/Milliman, InterQual, CMS standards, and HIPAA compliance.

• Educational Background: Bachelor’s degree required in Nursing, Healthcare Administration, Business Administration, or a related field (Master’s degree or MBA is a strong plus).

Other Requirements

• Highly Preferred Profile: Active U.S. Registered Nurse (USRN) license combined with recent, hands-on Utilization Management experience (Prior Authorization, Clinical Review, Medical Necessity, and related workflows). (Note: General BPO leadership without direct healthcare domain expertise will not qualify).

• Financial & Commercial Acumen: Proven P&L mindset with expertise in cost management, budgeting, staffing efficiency, attrition control, and margin optimization.

• Client & Stakeholder Mastery: Exceptional executive-level communication and presentation skills, with a track record of driving WBRs, MBRs, QBRs, and client governance forums.

• Nice-to-Have Advantages: Exposure to Medical Coding operations (ICD-10, CPT, HCC), Lean Six Sigma or Process Excellence certifications, and management of multi-program accounts.

Roles

• Strategic & Operational Leadership: Direct overall healthcare operations to consistently meet and exceed contractual SLAs, KPIs, quality, productivity, and compliance benchmarks across a 500–700 FTE organization.

• Healthcare Delivery & UM Oversight: Oversee complex healthcare workflows including Prior Authorization, prospective/concurrent/retrospective reviews, appeals and grievances, and medical necessity determinations with strict turnaround time discipline.

• Executive Client Governance: Serve as the primary executive sponsor for U.S. healthcare clients, building strong relationships, managing executive reviews, and proactively driving performance improvement initiatives.

• Financial & Margin Management: Own operational budgets, cost-to-serve discipline, staffing efficiencies, and P&L accountability without compromising service quality or regulatory compliance.

• Compliance & Risk Mitigation: Ensure rigid adherence to U.S. healthcare regulations, data protection policies, PHI, and HIPAA controls while maintaining continuous audit readiness.

• People Leadership & Talent Development: Mentor and develop multi-layered leadership teams (Directors, Senior Managers, Operations Managers), establishing robust succession planning and high-impact employee engagement strategies.

• Continuous Improvement & Transformation: Champion process standardization, automation, and data-driven decision-making to scale operations efficiently.