Executive Overview

An established healthcare operations organization is seeking a highly experienced Senior Director / Vice President to provide strategic direction and overall operational leadership for a large-scale Healthcare BPO environment.

This executive role will oversee an organization of approximately 500–700 FTEs, with primary responsibility for Utilization Management (UM), Care Management, and Disease Management. The ideal candidate must combine extensive healthcare domain knowledge with a strong track record in leading complex operations, managing senior leadership teams, and delivering measurable business results.

Candidates with an active USRN license and recent, hands-on Utilization Management experience are strongly preferred.

Leadership Scope and Accountabilities

1. Enterprise Operations Management

• Direct overall healthcare operations and ensure consistent delivery against KPIs, SLAs, quality, productivity, and compliance targets.

• Convert business objectives into operational strategies, execution plans, and measurable results.

• Lead Directors, Senior Managers, and Operations Managers across a 500–700 FTE organization.

• Maintain operational stability, scalability, and efficiency.

2. Healthcare Operations Expertise

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

• Ensure effective delivery of Prior Authorization, Prospective, Concurrent and Retrospective Reviews, Appeals and Grievances where applicable, Clinical Reviews, and Medical Necessity processes.

• Establish standardized workflows, quality controls, productivity benchmarks, and turnaround-time expectations.

• Ensure alignment with U.S. healthcare requirements and clinical guidelines.

3. Executive Client and Business Partnership

• Serve as the senior executive contact for healthcare clients and key stakeholders.

• Lead governance meetings, business reviews, and Quarterly Business Reviews (QBRs).

• Identify operational risks and drive performance improvement initiatives.

• Partner with Solutions, Transitions, and Sales teams on new launches, expansions, and strategic initiatives.

4. Financial and Commercial Management

• Oversee operational budgets, cost structures, and profitability.

• Drive staffing optimization, productivity improvement, attrition management, and process efficiency.

• Maintain accountability for revenue, margins, and cost-to-serve performance without compromising quality or compliance.

5. Compliance and Operational Governance

• Ensure adherence to HIPAA-aligned controls, PHI protection, and applicable U.S. healthcare regulations.

• Maintain audit readiness and effective internal controls.

• Work with Quality and Compliance teams to resolve audit findings and implement corrective actions.

6. Leadership Development and Transformation

• Build and develop high-performing senior leadership teams.

• Strengthen succession planning, employee engagement, retention, and leadership accountability.

• Use operational analytics and performance insights to drive business decisions.

• Lead continuous improvement, automation, digitization, and transformation initiatives.

Candidate Profile

Essential Requirements

• At least 10 years of Healthcare Operations experience within a BPO, shared services, or captive environment.

• Minimum 5 years in senior leadership positions at Director level or above.

• Demonstrated experience managing 500+ FTEs in complex, multi-layered operations.

• Recent, hands-on experience in at least one of the following: Utilization Management, Care Management, or Disease Management.

• Strong understanding of U.S. healthcare processes, clinical workflows, and medical terminology.

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

• Strong background in executive client management, operational governance, performance management, and business optimization.

• Experience in forecasting, budgeting, revenue management, and margin performance.

• Excellent strategic decision-making, communication, and stakeholder management capabilities.

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

Preferred Qualifications

• Active U.S. Registered Nurse (USRN) license.

• Recent, hands-on Utilization Management experience.

• Combination of clinical healthcare experience and large-scale healthcare BPO leadership.

• Direct experience in Prior Authorization, Clinical Review, and Medical Necessity workflows.

• Master's degree or MBA.

Additional Advantage

• Exposure to Medical Coding operations, including ICD-10, CPT, and HCC.

• Lean Six Sigma, Process Excellence, or continuous improvement certification.

• Experience overseeing multiple healthcare programs or accounts.

• Additional clinical or healthcare-related certifications.