Healthcare Operations VP: Utilization & Care Management

Gratitude Philippines; Manila; On-site; PHP 4,000,000 - 8,000,000; Full time

Job summary

Gratitude Philippines is seeking an experienced 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 oversee a 500–700 FTE organization, driving operational performance, client satisfaction, regulatory compliance, financial results, and leadership development.

A US healthcare background and proven ability to scale operations while ensuring HIPAA

Qualifications

• 10+ years of Healthcare Operations experience in a BPO, shared services, or captive environment.
• 5+ years in senior leadership roles at Director level or above.
• Proven experience managing 500+ FTEs in complex, multi-layered operations.
• Recent hands-on experience in Utilization Management (preferred), Care Management, or Disease Management.
• Strong knowledge of U.S. healthcare processes, clinical workflows, and medical terminology.
• Familiarity with MCG/Milliman, InterQual, CMS guidelines, and HIPAA.
• Proven experience in executive client management, operational governance, budgeting, and financial performance.
• Strong leadership, analytical, communication, and strategic decision‑making skills.
• Bachelor's degree in Nursing, Healthcare Administration, Business Administration, or a related field.

Responsibilities

• Provide strategic and operational leadership across large-scale healthcare programs.
• Oversee Utilization Management, Care Management, and Disease Management operations.
• Ensure achievement of contractual KPIs, SLAs, quality, productivity, and turnaround-time targets.
• Lead multi-layered leadership teams, including Directors, Senior Managers, and Operations Managers.
• Manage executive client relationships, governance meetings, and Quarterly Business Reviews.
• Drive budgeting, cost management, staffing efficiency, and P&L performance.
• Ensure compliance with HIPAA, PHI protection, and applicable U.S. healthcare requirements.
• Maintain audit readiness and oversee risk mitigation and corrective action plans.
• Develop leadership capabilities, succession plans, employee engagement, and retention strategies.
• Drive continuous improvement, operational transformation, automation, and process standardization.

Skills

Healthcare Operations

Leadership

Client Management

Budgeting

Regulatory Compliance

HIPAA Knowledge

FTE Management

Utilization Management

Care Management

Disease Management

Education

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

Tools

Lean Six Sigma

Job description

Gratitude Philippines is seeking an experienced 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 oversee a 500–700 FTE organization, driving operational performance, client satisfaction, regulatory compliance, financial results, and leadership development.

A US healthcare background and proven ability to scale operations while ensuring HIPAA