Operations Manager – Utilisation Management

Gratitude Inc

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5 days ago

Operations Manager – Utilisation Management

1-4 Year(s)

150 - 180 Thousand p.m

Manila

Job Description

Key Skills

HIPAA SLA Requirements Operations Manager Utilisation management USRN Manager BPO Health Process BPO Healthcare. Clinical Denials and appeals InterQual® or MCG InterQual Process

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Job Title: Operations Manager – Utilisation Management (USRN)

Location: On-site – Bridgetowne, Quezon City

Shift: Night shift (US hours), fixed weekends off

Salary Range: ₱150,000 – ₱180,000 (depending on experience)

Start Date: December 31, 2025 or ASAP

Work Setup: 100% On-site

We are looking for an experienced Operations Manager with an active USRN license to lead a Utilisation Management team focused on medical necessity reviews, clinical denials, and appeals for pre-service, concurrent, and retrospective cases in a healthcare/BPO environment.

Key Responsibilities:

Oversee end-to-end UM operations and ensure full compliance with SLAs, HIPAA, and all regulatory requirements

Drive continuous process improvement and operational efficiency

Manage team leaders/supervisors, monitor performance, and handle resource allocation & staffing

Act as the primary point of contact with stakeholders to maintain service quality and accuracy

Implement and monitor quality standards and clinical guidelines utilisation

Minimum Qualifications:

Active and valid US Registered Nurse (USRN) license

At least 1–2 years of managerial experience directly handling Team Leaders/Supervisors

Proven experience managing teams that perform Utilisation Management and clinical denials/appeals

Strong working knowledge of MCG, InterQual, NCQA, and/or ODG guidelines

Excellent English communication skills (verbal and written)

Willing to work fully on-site in Bridgetowne, Quezon City, on night shift (US hours), including holidays when needed

If you are a hands-on leader with solid Utilisation Management operations experience and ready to take on a high-impact managerial role, we want to hear from you!

How to Apply:

Send your updated CV to david.abulu@gratitudeindia.com or through DM.

Only shortlisted candidates will be contacted for the 2-round virtual interview process (Operations + possible assessment).

Role

Operations Manager

Timings

US-Type Shift (Permanent)

Industry

BPO

Work Mode

Work from office

Process

Voice

Functional Area

ITES / BPO / Customer Service

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