Clinical Operations Lead – UR/UM & Managed Care (Onsite)

Gratitude Philippines; Quezon; On-site; PHP 1,200,000 - 1,800,000; Full time

Job summary

Gratitude Philippines seeks an experienced Clinical Operations Assistant Manager to lead a high-performing clinical operations team supporting a major US managed care program. You will oversee daily operations, ensure quality and regulatory compliance, and drive team development across hybrid voice and back-office healthcare operations.

The ideal candidate will hold an active PH RN license and an unrestricted US RN license with NCLEX, plus a BSN and at least five years in clinical/healthcare ops

Qualifications

• BSN degree is required.
• Active Philippine Registered Nurse (PHRN) license.
• Active, unrestricted US Registered Nurse (USRN) license with NCLEX.
• 5+ years in clinical/healthcare operations.
• 3+ years in healthcare BPO/shared services leadership.
• Experience managing UR/UM operations.
• Strong knowledge of US managed care, CMS, HIPAA.
• Licenses must be active and current.
• Willingness to work onsite at Vertis North, Quezon City, on US day shift.

Responsibilities

• Oversee daily clinical operations to meet service levels, turnaround times, quality, and documentation targets.
• Monitor KPIs and SLAs; implement recovery plans as needed.
• Lead and develop RNs, clinical associates, and team leads; manage competency programs.
• Oversee UR/UM workflows and ensure compliance with payer requirements and timelines.
• Collaborate with WFM, TA, QA, training, and client stakeholders; drive process improvements.

Skills

Nursing leadership

Healthcare operations

HIPAA compliance

Regulatory compliance

Team coaching

Education

BSN

Job description

Gratitude Philippines seeks an experienced Clinical Operations Assistant Manager to lead a high-performing clinical operations team supporting a major US managed care program. You will oversee daily operations, ensure quality and regulatory compliance, and drive team development across hybrid voice and back-office healthcare operations.

The ideal candidate will hold an active PH RN license and an unrestricted US RN license with NCLEX, plus a BSN and at least five years in clinical/healthcare ops