Job Details

Job Title: Senior Director / Vice President of Operations Program: Healthcare 

Work Location: MOA, Pasay City 

Work Setup: 100% Onsite Shift Schedule: US Day Shift (Night Shift – Philippine Time) 

Salary Range: ₱250,000–₱350,000 

Target Start Date: ASAP

Salary Note: Compensation will depend on the candidate's current or previous salary, experience, and qualifications. Salary expectations must remain reasonable and aligned with the client's 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

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.

 Healthcare Delivery – Core Focus

* Oversee healthcare operations with direct experience in Utilization Management, Care Management, and Disease Management.

* Ensure operational excellence across the following healthcare processes:

    * 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.

 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.

 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.

 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.

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.

 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

* Candidates with an active U.S. Registered Nurse (USRN) license are highly preferred.

* Recent, hands-on Utilization Management experience is strongly preferred.

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

* Experience in Prior Authorization, Clinical Review, Medical Necessity, and related UM workflows is a strong advantage.

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

 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.

 RECRUITMENT PROCESS

* CV Validation.

* Phone Screening (Gratitude).

* TA Interview.

* Three interview rounds, with the final round conducted face-to-face.