Senior Director / Vice President of Operations – Healthcare (Utilization Management) – MOA, Pasay City

About the role

We are hiring a Senior Director / Vice President of Operations to lead a large healthcare BPO operation in MOA, Pasay City, with a focus on Utilization Management (UM), Care Management and Disease Management. You will own end-to-end delivery for a 500 to 700 FTE organization: client satisfaction, regulatory compliance, financial performance and people leadership. You will lead a layered team of Directors, Senior Managers and Operations Managers and act as executive sponsor for healthcare clients. The role needs deep, hands-on US healthcare domain expertise. It is 100% onsite on a US day shift (night shift, Philippine time), with a salary range of ₱250,000 to ₱350,000. There is 1 opening, and you can start ASAP.

Key responsibilities

Strategic and operational leadership

• Lead healthcare operations and meet contractual KPIs, SLAs, quality, productivity and compliance targets
  
• Turn business and client goals into operational strategy, execution plans and measurable results
  
• Lead a multi-layered leadership team of Directors, Senior Managers and Operations Managers
  
• Keep operations stable, efficient and scalable across healthcare programs
  

Healthcare delivery

• Oversee operations in Utilization Management, Care Management and Disease Management
  
• Ensure excellence in prior authorization, prospective, concurrent and retrospective reviews, appeals and grievances, and clinical review and medical necessity
  
• Keep standard workflows, productivity benchmarks, quality controls and turnaround discipline
  
• Drive efficiency while meeting US healthcare requirements
  

Client and stakeholder management

• Act as executive sponsor for healthcare clients and build strong senior relationships
  
• Lead governance forums, including weekly and monthly business reviews and QBRs
  
• Find operational risks early and run performance improvement plans
  
• Work with Solutions, Transitions and Sales on new program launches and expansions
  

Financial and commercial accountability

• Own cost management, budgeting and margin improvement
  
• Drive staffing efficiency, attrition management and productivity
  
• Keep a strong P&L mindset across leaders, without hurting service quality or compliance
  

Compliance, risk and governance

• Ensure strict adherence to healthcare regulatory, privacy and data protection rules, including PHI and HIPAA-aligned controls
  
• Keep operations audit-ready, and work with Quality and Compliance on findings and corrective actions
  

People and transformation

• Lead and develop a 500 to 700 FTE organization, with succession plans and strong engagement and retention
  
• Drive process improvement, automation and digital transformation using operational data and analytics
  

Required qualifications and experience

• 10+ years of healthcare operations in a BPO, shared services or captive environment
  
• 5+ years in senior leadership roles (Director, Senior Director or above)
  
• Experience managing 500+ FTEs in complex, multi-layered operations
  
• Recent, hands-on experience in Utilization Management (preferred), Care Management or Disease Management
  
• Strong understanding of US healthcare processes, clinical workflows and medical terminology
  
• Knowledge of MCG/Milliman, InterQual, CMS guidelines and HIPAA
  
• Executive client management, performance governance and operational optimisation experience
  
• Forecasting, budgeting and revenue and margin management experience
  
• Excellent communication, stakeholder management and strategic decision-making
  
• Bachelor’s degree in Nursing, Healthcare Administration, Business Administration or a related field
  
• Willing to work onsite in MOA on a US day shift (Philippine night shift)
  
• General BPO leadership without direct healthcare exposure is not sufficient
  

Preferred qualifications

• Active USRN license and recent hands-on UM experience (highly preferred)
  
• Prior authorization, clinical review and medical necessity experience
  
• Master’s degree or MBA
  
• Exposure to medical coding (ICD-10, CPT, HCC)
  
• Lean Six Sigma or process excellence certification
  
• Experience managing multiple healthcare programs or accounts
  
• Other clinical or healthcare certifications
  

Job details

Why join

• Executive role leading 500 to 700 people
  
• Salary of ₱250,000 to ₱350,000
  
• Direct client sponsorship and P&L ownership
  
• Healthcare program leadership across UM, care and disease management