Senior Director / Vice President of Operations – Healthcare

Location: MOA, Pasay City, Philippines
Work Setup: 100% Onsite
Shift: US Day Shift (Night Shift – Philippine Time)
Salary Range: PHP 250,000–350,000 per month
Headcount: 1
Target Start Date: ASAP

Compensation will depend on the candidate's current or previous salary, experience, and qualifications. Salary expectations must align with the client's approved budget.

Position Overview

We are seeking an accomplished 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 role will provide end-to-end operational leadership for a 500–700 FTE organization, driving operational excellence, client satisfaction, regulatory compliance, financial performance, and people development.

The ideal candidate will have extensive healthcare domain expertise, proven experience managing large-scale BPO operations, and the ability to lead multi-layered senior management teams.

USRN candidates with recent, hands-on Utilization Management experience are highly preferred. However, exceptional non-USRN healthcare operations leaders with recent UM, Care Management, or Disease Management experience will also be considered.

Key Responsibilities

1. Strategic & Operational Leadership

• Lead large-scale healthcare operations and ensure achievement of contractual KPIs, SLAs, quality, productivity, and compliance targets.

• Translate client and business objectives into operational strategies and measurable results.

• Manage multi-layered leadership teams, including Directors, Senior Managers, and Operations Managers.

• Ensure stable, scalable, and efficient service delivery.

2. Healthcare Operations & Clinical Processes

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

• Manage key workflows, including:

  • Prior Authorization

  • Prospective, Concurrent, and Retrospective Reviews

  • Clinical Review and Medical Necessity

  • Appeals and Grievance Operations, where applicable

• Establish standardized workflows, productivity targets, quality controls, and turnaround time requirements.

• Ensure compliance with U.S. healthcare processes and clinical standards.

3. Client & Stakeholder Management

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

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

• Identify operational risks and implement performance improvement plans.

• Collaborate with Sales, Solutions, and Transitions teams on new launches, expansions, and business initiatives.

4. Financial & Commercial Management

• Own operational budgets, cost management, and profitability initiatives.

• Drive staffing efficiency, productivity, attrition control, and process standardization.

• Maintain accountability for P&L, revenue, margins, and cost-to-serve.

• Balance financial performance with service quality and compliance.

5. Compliance & Risk Management

• Ensure compliance with HIPAA-aligned controls, PHI protection, privacy, and data security requirements.

• Maintain audit readiness and effective operational controls.

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

6. People Leadership & Transformation

• Lead and develop a 500–700 FTE organization.

• Mentor senior leaders and strengthen leadership capabilities and succession planning.

• Drive employee engagement, retention, accountability, and organizational performance.

• Implement process improvements, automation, digitization, and operational transformation initiatives.

• Use analytics and performance insights to improve efficiency, quality, and scalability.

Mandatory Qualifications

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

• Minimum 10 years of Healthcare Operations experience in a BPO, shared services, or captive environment.

• At least 5 years in senior leadership positions such as Director, Senior Director, AVP, VP, or equivalent.

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

• Recent, hands-on experience in one or more of the following:

  • Utilization Management (strongly 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 executive client management, operational governance, and performance management experience.

• Experience in budgeting, forecasting, P&L, revenue, and margin management.

• Strong leadership, communication, stakeholder management, and strategic decision-making skills.

Preferred: Master's degree or MBA.

Highly Preferred: USRN + Utilization Management

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

• Recent hands-on Utilization Management experience.

• Experience in Prior Authorization, Clinical Review, Medical Necessity, and related UM workflows.

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

Non-USRN candidates may be considered if they demonstrate exceptional healthcare leadership and recent, hands-on experience in UM, Care Management, or Disease Management.

Added Advantages (Nice to Have)

• Medical Coding exposure, including ICD-10, CPT, and HCC.

• Lean Six Sigma or Process Excellence certification.

• Experience managing multiple healthcare programs or accounts.

• Additional clinical or healthcare-related certifications.

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