JOB TITLE: SENIOR DIRECTOR / VICE PRESIDENT OF OPERATIONS

Program: Healthcare

Work Setup: 100% Onsite

Shift Schedule: US Day Shift (Night Shift – Philippine Time)

Target Start Date: ASAP

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

A. Strategic & Operational Leadership

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• Provide overall leadership and direction for healthcare operations, ensuring consistent achievement of contractual KPIs, SLAs, quality, productivity, and compliance standards.
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• Translate business and client objectives into operational strategies, execution plans, and measurable outcomes.
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• Lead large, multi-layered leadership teams, including Directors, Senior Managers, and Operations Managers.
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• Ensure stable, efficient, and scalable operations across healthcare programs.
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B. Healthcare Delivery – Core Focus

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• Oversee healthcare operations with direct experience in Utilization Management, Care Management, and Disease Management.
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• Ensure operational excellence across the following healthcare processes:
  
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  • Prior Authorization workflows.
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  • Prospective, Concurrent, and Retrospective Reviews.
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  • Appeals and Grievance Operations, where applicable.
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  • Clinical Review and Medical Necessity processes.
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• Ensure standardized workflows, productivity benchmarks, quality controls, and turnaround time discipline.
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• Drive operational efficiency while maintaining compliance with U.S. healthcare requirements.
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C. Client & Stakeholder Management

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• Act as the executive sponsor for healthcare clients, building strong relationships with senior client stakeholders.
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• Lead client governance forums, including weekly and monthly business reviews and Quarterly Business Reviews (QBRs).
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• Proactively identify operational risks and implement performance improvement plans.
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• Partner with Solutions, Transitions, and Sales teams on new program launches, expansions, and business initiatives.
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D. Financial & Commercial Accountability

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• Own operational cost management, budgeting, and margin improvement initiatives.
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• Drive staffing efficiency, attrition management, productivity optimization, and process standardization.
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• Maintain a strong P&L mindset across leadership teams.
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• Ensure cost-to-serve discipline without compromising service quality and compliance.
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E. Compliance, Risk & Governance

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• Ensure strict adherence to healthcare regulatory, privacy, and data protection requirements, including PHI and HIPAA-aligned controls.
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• Maintain audit readiness and strong internal controls for healthcare and UM operations.
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• Partner with Quality and Compliance teams to address audit findings, mitigate risks, and implement corrective actions.
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F. People Leadership & Talent Development

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• Lead and inspire a 500–700 FTE organization.
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• Develop and mentor senior leadership teams, including Directors, Senior Managers, and Operations Managers.
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• Establish succession plans and strengthen leadership capabilities.
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• Drive employee engagement, retention, accountability, and overall organizational performance.
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G. Continuous Improvement & Transformation

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• Identify and implement process improvements to drive efficiency, quality, and scalability.
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• Leverage operational data, analytics, and performance insights for fact-based decision-making.
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• Support automation, digitization, and transformation initiatives aligned with healthcare operations.
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QUALIFICATIONS & REQUIREMENTS

Mandatory Qualifications

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• 10+ years of Healthcare Operations experience in a BPO, shared services, or captive environment.
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• 5+ years of experience in senior leadership roles (Director, Senior Director, or equivalent and above).
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• Proven experience managing 500+ FTEs in complex, multi-layered operations.
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• Recent, hands-on experience in at least one or more of the following:
  
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  • Utilization Management (UM) – Preferred.
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  • Care Management.
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  • Disease Management.
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• Strong understanding of U.S. healthcare processes, clinical workflows, and medical terminology.
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• Knowledge of MCG/Milliman, InterQual, CMS guidelines, and HIPAA.
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• Proven experience in executive client management, performance governance, and operational optimization.
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• Strong background in performance management, leadership development, and operational analytics.
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• Experience in forecasting, budgeting, and managing revenue and margin performance.
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• Excellent communication, stakeholder management, and strategic decision-making skills.
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• Bachelor's degree required in Nursing, Healthcare Administration, Business Administration, or a related field.
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• Master's degree or MBA is preferred but not mandatory.
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Highly Preferred: USRN + Utilization Management Experience

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• Candidates with an active U.S. Registered Nurse (USRN) license are highly preferred.
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• Recent, hands-on Utilization Management experience is strongly preferred.
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• Candidates with both clinical healthcare experience and large-scale healthcare BPO operational leadership will be prioritized.
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• Experience in Prior Authorization, Clinical Review, Medical Necessity, and related UM workflows is a strong advantage.
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IMPORTANT: General BPO leadership experience without direct healthcare domain exposure will not be sufficient for this position.

ADDED ADVANTAGE (NICE TO HAVE)

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• Exposure to Medical Coding operations, including ICD-10, CPT, and HCC.
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• Lean Six Sigma, Process Excellence, or other continuous improvement certifications.
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• Experience managing multiple healthcare programs or accounts.
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• Additional clinical or healthcare-related certifications.
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NOTE: Medical Coding experience is an added advantage, not a mandatory requirement.