Head of Medical Operations

5 days ago


Manila, National Capital Region, Philippines Private Advertiser Full time
  1. Plans programs, strategies and controls of the Division that are aligned to the company's objectives.
  2. Develops and formulates policies related to operations of the Division and its different Departments.
  3. Evaluates and conceptualizes the formulation and implementation of the Division's business processes, customer experience and managed care strategies for the company.
  4. Approves affiliations for dental, wellness, clinic and hospital providers in accordance with providing access to quality medical services to all our clients.
  5. Develops and maintains relations with medical, dental and wellness providers, and corporate accounts as well.
  6. Evaluates and validates diagnosis of member's medical condition and recommends approval or disapproval of cases according to the account's benefit plan within the authority limits.
  7. Implements Primary Care Services for members by providing strategic primary care clinic set up with the twin goal of facilitating customer service and utilization management.
  8. Evaluates and recommend approval for rating of life and medical insurance applications for retail and group marketing products.
  9. Recommends medical underwriting inputs especially for large cases with medical findings.
  10. Evaluates staff performance and makes necessary recommendation such as counselling, coaching, commendations or promotions.
  11. Reviews and approves hiring of Medical Operations staff.
  12. Approves necessary materials and other necessities for department use, i.e., cash advances and reimbursement as requested by the Department Heads and Managers.
  13. Evaluates, plans and recommends budget and resources.
  14. Represents the department and unit in internal and external meetings and makes presentations pertaining to the Departments' activities and plans.
  15. Attends company business planning sessions, training seminars and other company related activities.
  16. Performs other tasks as assigned from time to time.
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