Director of Clinical Operatons|MOA Pasay

Gratitude Philippines; Manila; Sur place; PHP 1 200 000 - 1 800 000; Plein temps

Résumé du poste

Gratitude Philippines is seeking a seasoned Senior Director / Vice President of Operations to lead large-scale Healthcare BPO operations, with a focus on Utilization Management, Care Management, and Disease Management. You will provide end-to-end operational leadership for a 500–700 FTE organization, ensuring client satisfaction, regulatory compliance, financial performance, and strong people management.

Prior US healthcare experience is highly valued.

Qualifications

• 10+ years of healthcare operations experience in a BPO/shared services/captive environment.
• 5+ years in senior leadership roles (Director/Senior Director or equivalent+)
• Proven experience managing 500+ FTEs in complex, multi-layered operations.
• Recent hands-on experience in Utilization Management, Care Management, or Disease Management.
• Strong understanding of US healthcare processes and medical terminology.
• Knowledge of HIPAA and related privacy requirements.
• Proven experience in executive client management and governance.
• Experience in forecasting, budgeting, and revenue/margin performance.
• Excellent communication and stakeholder management skills.
• Bachelor's degree required; Master's preferred.

Responsabilités

• Provide end-to-end leadership for 500–700 FTE healthcare operations.
• Drive KPIs, SLAs, quality, productivity, and compliance.
• Lead senior leadership teams across Directors and Managers.
• Oversee UM, Care Management, and Disease Management processes.
• Partner with client stakeholders in governance forums.
• Own budgeting, cost-to-serve, and margin improvement.
• Ensure PHI/HIPAA compliance and audit readiness.
• Lead continuous improvement and transformation initiatives.
• Foster talent development and succession planning.

Connaissances

Leadership

Healthcare operations

Executive client management

Strategic decision-making

Formation

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

Master's degree or MBA (preferred)

Outils

MCG/Milliman guidelines

InterQual

CMS guidelines

HIPAA knowledge

Description du poste

Program: Healthcare

Work Location: MOA, Pasay City

Work Setup: 100% Onsite

Shift Schedule: US Day Shift (Night Shift – Philippine Time)

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.

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.