Job Summary

We are seeking an experienced Senior Director / Vice President of Operations to lead large-scale Healthcare BPO operations, with a strong focus on Utilization Management (UM), Care Management, and Disease Management.

The role will oversee a 500–700 FTE organization, driving operational performance, client satisfaction, regulatory compliance, financial results, and leadership development.

Key Responsibilities

• Provide strategic and operational leadership across large-scale healthcare programs.

• Oversee Utilization Management, Care Management, and Disease Management operations.

• Ensure achievement of contractual KPIs, SLAs, quality, productivity, and turnaround-time targets.

• Lead multi-layered leadership teams, including Directors, Senior Managers, and Operations Managers.

• Manage executive client relationships, governance meetings, and Quarterly Business Reviews.

• Drive budgeting, cost management, staffing efficiency, and P&L performance.

• Ensure compliance with HIPAA, PHI protection, and applicable U.S. healthcare requirements.

• Maintain audit readiness and oversee risk mitigation and corrective action plans.

• Develop leadership capabilities, succession plans, employee engagement, and retention strategies.

• Drive continuous improvement, operational transformation, automation, and process standardization.

Mandatory Qualifications

• 10+ years of Healthcare Operations experience in a BPO, shared services, or captive environment.

• 5+ years in senior leadership roles at Director level or above.

• Proven experience managing 500+ FTEs in complex, multi-layered operations.

• Recent, hands-on experience in Utilization Management (preferred), Care Management, or Disease Management.

• Strong knowledge of U.S. healthcare processes, clinical workflows, and medical terminology.

• Familiarity with MCG/Milliman, InterQual, CMS guidelines, and HIPAA.

• Proven experience in executive client management, operational governance, budgeting, and financial performance.

• Strong leadership, analytical, communication, and strategic decision-making skills.

• Bachelor's degree in Nursing, Healthcare Administration, Business Administration, or a related field.

Other recommendation 

• Active U.S. Registered Nurse (USRN) license.

• Recent, hands-on Utilization Management experience.

• Clinical healthcare background combined with large-scale BPO operational leadership.

• Medical Coding exposure, including ICD-10, CPT, and HCC.

• Lean Six Sigma or Process Excellence certification.

• Experience managing multiple healthcare programs or accounts.

• Additional clinical or healthcare-related certifications.

• Master's degree or MBA.