Senior Manager, Hospital Operations Services

aia; Makati; On-site; PHP 2,000,000 - 3,600,000; Full time

Job summary

MediCard Phils., Inc. is seeking a dynamic leader to head Hospital Operations Services. The role focuses on implementing healthcare benefits delivery, ensuring medical necessity, and maintaining high-quality services across accredited facilities nationwide.

You will drive operational excellence, balance member satisfaction with cost containment, and lead multidisciplinary teams to sustain access, affordability, and quality of care.

Responsibilities

• Lead Hospital Operations Strategy and Performance: set standards and metrics across hospital operations; drive improvements for member experience and performance.
• Oversee Utilization Management and Medical Necessity Reviews: manage pre-authorization, concurrent review, case management, and discharge planning to ensure appropriate care.
• Manage Hospital and Provider Relations: build partnerships with hospitals and providers; resolve operational issues and improve service levels.
• Drive Quality, Patient Safety and Clinical Governance: ensure adherence to evidence-based medicine, monitor outcomes, lead audits and improvement initiatives.
• Ensure Excellence in Member Experience: streamline approvals and service requests; improve access and affordability.
• Manage Financial Performance and Costs: monitor utilization and costs; support cost-management targets and efficient resource use.
• Lead and Develop Teams: coach and develop Hospital Operations, Utilization Management, and Medical Review teams.

Job description

MediCard Phils., Inc.is one of the country's leading HMOand the only HMOfounded and run by Doctors. Since its inception, the concept of service-oriented total health care has been the molding ideal of MediCard. The competition is vast, and the benefits being offered by the competitors are tempting. However, MEDICard has taken the lead in providing innovative and productive ideas that cut down the cost of health maintenance without compromising its quality.

MediCardnow boasts of more than half a million members and over 54,000 accredited doctors in over 1,000 hospitals and clinics nationwide. It also operates 16 MediCard free-standing clinics that provide services at par with those offered by hospitals minus the confinement.

MediCardis currentlylooking for assertive, dynamic and energetic individuals to fill up the following vacancy:

Lead and manage the Hospital Operations Services function to ensure the efficientimplementation of healthcare benefits and delivery of high-quality medical services to membersacross accredited hospitals and healthcare facilities. Drive operational excellence by ensuringthat inpatient and outpatient healthcare services are approved based on medical necessity,evidence-based medicine, right treatment setting, right time, and benefit entitlement whilebalancing member satisfaction, quality outcomes, provider engagement, and cost containment.The role ensures healthcare services are accessible, affordable, easy, predictable, and alignedwith organizational objectives, regulatory requirements, and clinical governance standards.

• 1. Lead Hospital Operations Strategy and Performance (20%) Develop and execute operational strategies, policies, and programs that support the organization's healthcare delivery objectives. Establish service standards and operational performance metrics across all hospital operations functions. Monitor operational trends and recommend improvements to enhance member experience and organizational performance. Lead strategic initiatives focused on healthcare accessibility, affordability, and quality outcomes.
• 2. Oversee Utilization Management and Medical Necessity Reviews (25%) Ensure all inpatient, outpatient, emergency, and ancillary service approvals are evaluated based on medical necessity, evidence-based guidelines, benefit coverage, and appropriateness of care. Direct pre-authorization, concurrent review, case management, and discharge planning activities. Review high-cost and complex medical cases to ensure optimal treatment outcomes and resource utilization. Implement controls to reduce unnecessary admissions, procedures, diagnostics, and prolonged hospital stays.
• 3. Manage Hospital and Provider Relations (15%) Develop and maintain strong partnerships with accredited hospitals, physicians, and healthcare providers. Resolve escalated operational concerns affecting healthcare service delivery. Collaborate with Provider Relations and Network Management teams to improve healthcare provider performance and service levels. Participate in discussions related to hospital operational issues, healthcare trends, and service enhancements.
• 4. Drive Quality, Patient Safety and Clinical Governance (10%) Ensure clinical decisions and authorization processes comply with evidence-based medicine and established clinical guidelines. Monitor quality indicators and healthcare outcomes.
  Identify opportunities for clinical and operational improvement. Lead medical audits, utilization reviews, and healthcare quality initiatives.
• 5. Ensure Excellence in Member Experience (10%) Establish processes that improve healthcare access and simplify the member journey. Monitor and improve turnaround times for approvals and healthcare service requests. Address complex member concerns and high-impact service issues. Ensure consistent delivery of accessible, affordable, easy, and predictable healthcare experiences.
• 6. Manage Financial Performance and Healthcare Costs (10%) Monitor healthcare utilization trends, inpatient and outpatient expenditures, and medical cost drivers. Develop initiatives that improve cost efficiency while maintaining quality care outcomes. Support achievement of Medical Loss Ratio (MLR), healthcare utilization, and cost management targets. Provide recommendations to optimize healthcare spending and resource utilization.
• 7. Lead and Develop Teams (10%) Provide leadership, coaching, and performance management to Hospital Operations, Utilization Management, Case Management, and Medical Review teams. Foster a culture of accountability, collaboration, service excellence, and continuous improvement. Develop succession plans and talent development programs within the department.

You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date.