Important Hiring Restrictions

Former Teleperformance (TP) employees are not eligible for rehire, either directly or through a third party.

Candidates with previous employment at PSG Global, Majorel, or Aegis are also ineligible under the client’s hiring restrictions, as these companies are included in the Teleperformance-related exclusion.

Job Overview

Lead a high-performing clinical operations team supporting a major US managed care program. Drive service excellence, clinical quality, and team development in a fast-paced, metrics-driven environment.

Key Responsibilities

• Own daily SLA/KPI performance, including turnaround time, quality, productivity, and documentation.
• Conduct team huddles, interval monitoring, root cause analysis (RCA), and performance recovery planning.
• Ensure strict compliance with HIPAA and PHI requirements.
• Lead clinical quality assurance through audits, calibrations, coaching, and documentation reviews.
• Develop and mentor registered nurses (RNs), clinical associates, and team leaders.
• Manage competency programs, preceptorship, continuing education (CE) tracking, and license validity.
• Collaborate with Workforce Management (WFM), Talent Acquisition (TA), Quality Assurance (QA), and client stakeholders.
• Translate clinical protocol updates into practical workflows and training materials.

Qualifications

• Bachelor of Science in Nursing (BSN) graduate with an active Philippine RN license.
• Active, unrestricted USRN license (NCLEX passed).
• At least 5 years of clinical and healthcare operations experience.
• At least 3 years of team leadership experience in healthcare BPO or shared services.
• Strong knowledge of US managed care, Utilization Management (UM), Case Management (CM), CMS, and HIPAA.
• Proven experience managing SLAs, KPIs, and clinical operational performance.
• Background in Utilization Review (UR)/Utilization Management (UM), with current experience managing UR operations.
• Experience in UM, CM, Health Risk Assessment (HRA), triage, or payer operations is preferred.
• Familiarity with URAC/NCQA standards is an advantage.
• Training experience is preferred.
• Willing to work onsite on a US day shift.
  

USRN License Validity: The license must be active. Candidates whose licenses are nearing expiration must be willing to renew it.

Required Assessment

• Candidates must complete an on-the-spot clinical review writing assessment during the interview.
• Please advise candidates in advance that a laptop or desktop computer is required to complete the assessment.
  

Recruitment Process

• Profile Validation
• Profile Review
• Talent Acquisition (TA) Interview
• Hiring Manager (HM) Interview
• Client Interview