Senior Manager, Hospital Operations Services

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 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 efficient
implementation of healthcare benefits and delivery of high-quality medical services to members
across accredited hospitals and healthcare facilities. Drive operational excellence by ensuring
that inpatient and outpatient healthcare services are approved based on medical necessity,
evidence-based medicine, right treatment setting, right time, and benefit entitlement while
balancing member satisfaction, quality outcomes, provider engagement, and cost containment.
The role ensures healthcare services are accessible, affordable, easy, predictable, and aligned
with organizational objectives, regulatory requirements, and clinical governance standards.

1. 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. 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. 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. 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. 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. 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. 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.