Utilization Management Director — Healthcare Leader

Gratitude Philippines

Manila

On-site

PHP 2,790,000 - 3,906,000

Full time

2 days ago

Be an early applicant

Get a reply from this employer

Your resume and cover letter, tailored to exactly what they’re hiring for.

Get past ATS filters

Job summary

Gratitude Philippines is seeking a Director of Utilization Management to lead a large-scale US healthcare operations function in the Philippines. The role demands hands-on UM experience, strong leadership of 500+ FTEs, and deep knowledge of medical necessity and prior authorization processes.

You will drive performance, governance, and client outcomes across on-site teams. The ideal candidate has 10+ years in healthcare operations, a nursing or allied degree, and familiarity with CMS/HIPAA

Qualifications

10+ years of Healthcare Operations experience.
5+ years in senior management or director roles.
Experience leading 500+ FTEs.
Recent hands-on Utilization Management experience preferred.
Strong knowledge of US healthcare clinical workflows.
Familiarity with MCG/Milliman, InterQual, CMS, HIPAA.
Experience in client management, governance, budgeting, and performance management.
Bachelor's degree in Nursing, Healthcare Administration, Business Administration, or related field.

Responsibilities

Lead large-scale Utilization Management and related healthcare operations.
Oversee Prior Authorization and prospective, concurrent, and retrospective reviews.
Ensure clinical review accuracy and compliance with Medical Necessity.
Manage Appeals and Grievance operations where applicable.
Drive KPIs, turnaround times, quality and productivity.
Establish standardized clinical and operational workflows.
Ensure HIPAA/CMS compliance and US healthcare requirements.
Manage senior operational leaders and develop high-performing teams.
Partner with healthcare clients to improve service delivery and performance.
Drive process improvements, resource optimization and efficiency.