Senior Director / Vice President of Operations – Healthcare

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)
Headcount: 1
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

A. 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.

B. 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.

C. 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.

D. 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.

E. 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.

F. 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.

G. 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.

4. ADDED ADVANTAGE (NICE TO HAVE)
• Exposure to Medical Coding operations, including ICD-10, CPT, and HCC.
• Lean Six Sigma, Process Excellence, or other continuous improvement certifications.
• Experience managing multiple healthcare programs or accounts.
• Additional clinical or healthcare-related certifications.

***Note: Medical Coding experience is an added advantage, not a mandatory requirement.***