​Urgent Hiring | US Healthcare Operations | Up to ₱350,000 Monthly

Are you an experienced Utilization Management leader with a strong understanding of US healthcare clinical operations?

We are looking for an accomplished Director of Utilization Management with hands-on experience in Prior Authorization, Clinical Review, Medical Necessity, and large-scale healthcare BPO operations.

USRN professionals with recent Utilization Management experience are strongly encouraged to apply.

Key Responsibilities

• Lead large-scale Utilization Management and related healthcare operations.

• Oversee Prior Authorization and Prospective, Concurrent, and Retrospective Reviews.

• Ensure clinical review accuracy and compliance with Medical Necessity requirements.

• Manage Appeals and Grievance operations, where applicable.

• Drive operational KPIs, turnaround times, quality, and productivity.

• Establish standardized clinical and operational workflows.

• Ensure compliance with HIPAA, CMS guidelines, and applicable US healthcare requirements.

• Manage senior operational leaders and develop high-performing teams.

• Partner with healthcare clients to improve service delivery and operational performance.

• Drive process improvements, resource optimization, and operational efficiency.

Mandatory Qualifications

• 10+ years of Healthcare Operations experience.

• 5+ years of senior management or director-level experience.

• Experience leading 500+ FTEs.

• Recent hands-on experience in Utilization Management is highly preferred.

• Strong understanding of US healthcare clinical workflows.

• Knowledge of Prior Authorization, Clinical Review, and Medical Necessity.

• Familiarity with MCG/Milliman, InterQual, CMS guidelines, and HIPAA.

• Experience in client management, operational governance, budgeting, and performance management.

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

<badge color="success">Top Preference: USRN + Hands-on UM Experience</badge>

Candidates with active USRN licenses and recent practical experience in Utilization Management will receive priority consideration. Exceptional non-USRN healthcare operations leaders with direct UM experience are also welcome.

Additional Advantage

• Care Management or Disease Management experience.

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

• Lean Six Sigma certification.

• Experience managing multiple US healthcare programs.

Important Eligibility Restrictions

Former employees of the following companies are NOT eligible:

• Teleperformance (TP)

• PSG Global

• Majorel

• Aegis

Candidate Prescreening Questions

1. Are you an active USRN?

2. How many years of Utilization Management experience do you have?

3. Have you managed Prior Authorization operations?

4. What types of clinical reviews have you handled?

5. Are you familiar with MCG/Milliman and InterQual?

6. Do you have Care Management or Disease Management experience?

7. What is your total Healthcare Operations experience?

8. What is the largest FTE team you have managed?

9. Current/Last Drawn Salary?

10. Expected Salary?

11. Current Location?

12. Notice Period?

13. LinkedIn Profile?

14. Previous employment with TP, PSG Global, Majorel, or Aegis?

Salary: ₱250,000–₱350,000 monthly, depending on experience and qualifications.

Location: MOA, Pasay City | 100% Onsite | US Day Shift (Philippine Night Shift)

Apply now for this senior-level US healthcare Utilization Management leadership opportunity!