Healthcare Operations Manager

2 weeks ago

Manila, National Capital Region, Philippines Nezda Global Full time ₱1,200,000 - ₱3,600,000 per year

About the Role

We're hiring a
USRN Senior Operations Manager
to lead our Pharmacy Prior Authorization division. You'll oversee end-to-end PA operations across multiple intake channels, manage clinical decision compliance, drive engagement across a large workforce, and spearhead technology-enabled process improvements.

This role requires deep understanding of both
medical and pharmacy benefit utilization review
and the ability to bring structure, clarity, and strategy to a fast-moving environment.

Key Responsibilities

  • Lead supervisors and multidisciplinary teams; build a culture of engagement and accountability.
  • Set performance goals, track KPIs, and drive continuous operational improvement.
  • Oversee the full Prior Authorization workflow to ensure timely, accurate, and compliant decisions.
  • Manage escalations, appeals, audit findings, and exception handling.
  • Collaborate with IT, pharmacists, medical directors, quality, training, and compliance teams.
  • Drive innovation by partnering on AI-enabled tools and workflow automation.
  • Analyze data trends and prepare executive-level performance reports.
  • Support training programs, talent development, and certification pathways for staff.

Must-Have Qualifications

  • Active USRN license
    (required).
  • Experience in
    pharmacy, specialty medications, or utilization management
    .
  • Strong leadership and people-management experience in operations.
  • Advanced proficiency in
    MS Office
    and analytics/reporting tools.
  • Proven ability to manage complex workflows and cross-functional teams.
  • Exceptional communication, problem-solving, and organizational skills.

Good-to-Have

  • Six Sigma or Lean certification.
  • Experience in process optimization or technology-driven transformation projects.

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