Senior Director / Vice President of Operations – Healthcare

Work Location: MOA, Pasay City

Work Setup: 100% Onsite

Shift: US Day Shift (Philippine Night Shift)

Start Date: ASAP

Job Description

Lead large-scale Healthcare BPO operations covering Utilization Management (UM), Care Management, and Disease Management. Oversee a 500–700 FTE organization, ensuring operational excellence, client satisfaction, compliance, financial performance, and effective team management.

Key Responsibilities

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

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

- Manage Prior Authorization, Clinical Reviews, Medical Necessity, Appeals, and Grievance processes.

- Lead senior management teams and develop leadership capabilities.

- Manage client relationships, business reviews, and operational performance.

- Oversee budgeting, cost management, productivity, and profitability.

- Ensure compliance with HIPAA, PHI, and U.S. healthcare regulations.

- Drive process improvements, automation, and operational efficiency.

Qualifications & Requirements

- 10+ years of Healthcare Operations experience.

- 5+ years in senior leadership positions.

- Experience managing 500+ FTEs.

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

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

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

- Experience in client management, budgeting, forecasting, and P&L.

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

- Master's degree or MBA preferred.

Highly Preferred

- Active USRN license.

- Recent hands-on Utilization Management experience.

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

- Strong combination of clinical healthcare knowledge and BPO leadership.

Important: General BPO leadership without direct healthcare experience is not sufficient.

Added Advantage

- Medical Coding knowledge (ICD-10, CPT, HCC).

- Lean Six Sigma or Process Excellence certification.

- Experience managing multiple healthcare programs.

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