Clinical Operations Director

Optum, a UnitedHealth Group Company; Makati; On-site; PHP 2,400,000 - 4,800,000; Full time

Job summary

Optum Philippines is seeking an experienced senior manager to lead medical and clinical operations, coordinating care and policies across a large team. You will guide staff with clinical acumen, oversee utilization and case management, and ensure alignment with US healthcare standards.

This role requires onsite presence in Makati with night shifts supporting US clients. Ideal candidates bring 10+ years in UM/CM/MTM, 3+ years of management, and proven leadership of large teams.

Qualifications

• 10+ years of experience in Utilization Management, Case Management, MTM or related clinical decision functions.

Responsibilities

• Lead and manage multiple Medical & Clinical Operations functions.
• Provide leadership to managers and senior staff.
• Guide staff with clinical insights to navigate the medical management system.
• Oversee coordination of care including chronic condition management and utilization.
• Develop policies and guidelines for medical and clinical operations programs.
• Comply with employment contracts, policies, and directives.

Skills

Utilization Management

Case Management

Medication Therapy Management

InterQual

MCG

Clinical guidelines

Analytical skills

Communication skills

Leadership

Healthcare BPM

Education

Bachelor's degree in Healthcare Administration

Master's in Health Administration

Tools

InterQual

MCG

Electronic Health Records (EHR)

Job description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Primary Responsibilities:

• Position in this function includes those responsible for management and administration of multiple Medical & Clinical Operations Functions, or managing general operations which are not specific to one of the functions in the Medical & Clinical Operations job family
• Provides leadership to and is accountable for the performance of managers and/or senior level professional staff
• Leverage clinical acumen to provide guidance to staff (e.g., disease state, health conditions). Assist staff in navigating the medical management system (e.g., find resources, answers questions)
• Provide oversight and review of coordination of care (e.g., chronic condition management, utilization management, case management)
• Develop policies, procedures, and guidelines for medical and clinical operations programs and review/approve policy and process changes
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

• 10+ years of experience in Utilization Management, Case Management, Medication Therapy Management (MTM), and/or other clinical decision‑making functions, with demonstrated proficiency in InterQual, MCG, Medical Policies, and other clinical guidelines
• 3+ years of managerial experience, preferably within a Healthcare Business Process Management (BPM) environment
• Proven experience leading large‑scale teams of 100 or more FTEs
• Experience in Utilization Management (UM) or Healthcare Business Process Management
• Demonstrated success in building, developing, and leading high‑performing teams
• Proven solid computer literacy, with advanced analytical and problem‑solving skills
• Proven excellent communication, interpersonal, and organizational skills, with the ability to collaborate effectively across clinical and operational stakeholders
• Willing to work in Night Shift and report to any of the sites - Makati, Alabang, QC and Taguig
• Willing to report onsite (5x a week)

Preferred Qualification:

• Experience working in US healthcare businesses and working with US clients

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone‑of every race, gender, sexuality, age, location and income‑deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

Optum is a drug‑free workplace. © 2026 Optum Global Solutions (Philippines) Inc. All rights reserved.