Operations Manager - Utilization Management (USRN Required)

Job Title: Operations Manager - Utilisation Management (USRN Required)

Shift: Night shift (aligned with US hours)

Work Set-up: On-site in Bridgetowne, Quezon City

Salary Range: PHP 150,000 - 180,000

Start Date: December 31, 2025 or ASAP

Line of Business Overview:

Utilisation Management focused on medical necessity approvals and denials for pre-service, retrospective, and concurrent services in a healthcare/BPO environment.

Job Summary:

The Operations Manager will oversee Utilisation Management operations, ensure compliance with industry standards and regulatory requirements, and drive team performance to deliver high-quality outcomes. This role involves close collaboration with stakeholders to optimise processes and maintain service excellence.

Key Responsibilities:

• Oversee daily operations and ensure adherence to SLAs and regulatory standards.
• Develop and implement process improvement initiatives.
• Manage team performance, resource allocation, and staffing accuracy.
• Collaborate with internal and external stakeholders to enhance service delivery.
• Ensure strict compliance with HIPAA and other applicable regulations.

Qualifications:

• Bachelor's Degree in Nursing with an active and valid US Registered Nurse (USRN) license.
• At least 1-2 years of managerial experience leading Team Leaders, Supervisors, or similar roles.
• Proven experience managing teams that handle Utilisation Management and clinical denials.
• Hands-on experience in appeals/denials, utilisation review, or related healthcare management functions.
• Strong familiarity with Medical Guidelines (e.g., MCG, InterQual, NCQA, ODG).
• Excellent verbal and written English communication skills.
• Willing to work on-site with flexible schedules, including night shifts, US hours, and holidays.

Recruitment Process:

2 interviews (operations-focused, virtual possible), plus potential assessment based on interview recommendations.

If you meet the qualifications and are ready to lead a high-impact Utilisation Management team, we invite you to apply today! Submit your updated resume and answer the screening questions below.