Senior Director, Hospital Operations & Utilization Management

Hammerjack Pty Ltd; Philippines; On-site; PHP 1,800,000 - 2,400,000; Full time

Job summary

MediCard Phils., Inc. is seeking an assertive, dynamic Leader to head Hospital Operations Services to ensure the efficient implementation of healthcare benefits and the delivery of high-quality medical services to members across accredited hospitals and clinics.

You will drive operational excellence, oversee medical necessity reviews, maintain provider relations, and uphold clinical governance while balancing member satisfaction, cost containment, and regulatory compliance.

Qualifications

• Lead Hospital Operations Strategy and Performance across all hospital functions.
• Oversee Utilization Management and Medical Necessity Reviews.
• Develop Hospital and Provider Relations with accredited hospitals and physicians.
• Drive Quality, Patient Safety and Clinical Governance through audits and guidelines.
• Ensure Excellence in Member Experience by improving access and turnaround times.
• Manage Financial Performance and Healthcare Costs and cost containment.
• Lead and develop teams in Hospital Operations, Utilization Management and Medical Review.

Responsibilities

• Lead Hospital Operations Strategy and Performance: develop and execute strategies, policies, and programs.
• Oversee Utilization Management and Medical Necessity Reviews: direct pre-authorization, concurrent review, case management, discharge planning.
• Manage Hospital and Provider Relations: build partnerships with hospitals and providers, resolve escalated issues.
• Drive Quality, Patient Safety and Clinical Governance: monitor quality indicators and lead audits and reviews.
• Ensure Excellence in Member Experience: improve access and turnaround times for approvals and requests.
• Manage Financial Performance and Healthcare Costs: monitor expenditures and support cost-management targets.
• Lead and develop teams: coach and develop Hospital Operations and related teams.

Job description

MediCard Phils., Inc. is seeking an assertive, dynamic Leader to head Hospital Operations Services to ensure the efficient implementation of healthcare benefits and the delivery of high-quality medical services to members across accredited hospitals and clinics.

You will drive operational excellence, oversee medical necessity reviews, maintain provider relations, and uphold clinical governance while balancing member satisfaction, cost containment, and regulatory compliance.