Team Leader for Utilization Management Healthcare Operations

Location: Valero, Makati City, Metro Manila, Philippines. The role is onsite, with possible remote or hybrid eligibility after training and subject to sustained performance and operational requirements. Office attendance may still be required for training, meetings, coaching, client visits, security, and business needs. Schedule: graveyard and shifting hours.

Company

Healthcare operations partner supporting healthcare payers through administrative processes and workflow technology, with secure facilities in the United States and Manila.

What you will do

• Lead the daily activities of Utilization Management Coordinators and support staff.
• Monitor authorization queues, referral requests, workload distribution, turnaround times, attendance, productivity, and schedule adherence.
• Coach team members, conduct one-on-one discussions, and support engagement, accountability, and performance improvement.
• Ensure accurate documentation and compliance with SOPs, client requirements, regulatory standards, HIPAA, and data privacy rules.
• Collaborate with QA, Training, Workforce Management, licensed clinical teams, HR, and operations leadership.
• Prepare operational reports, identify risks, and support workflow optimization and continuous improvement initiatives.

Requirements

• High school diploma required; bachelor's degree preferred.
• 3–5 years of experience in healthcare operations, utilization management, prior authorization, claims, provider services, member services, or managed care.
• At least 1 year of experience as a Team Leader, Lead, SME, Escalation Lead, or people leader.
• Strong understanding of healthcare payer operations and working knowledge of medical terminology.
• Strong leadership, coaching, communication, analytical, organizational, and problem-solving skills.
• Intermediate to advanced Microsoft Office skills.

Culture & Benefits

• Onsite work during initial training and other operational periods, with performance-based eligibility for remote or hybrid work.
• Remote work requires a secure environment, reliable internet, appropriate equipment, technical readiness, and compliance with HIPAA, privacy, security, and client requirements.
• Comprehensive HMO coverage including medical and dental benefits.
• HMO coverage from day one plus coverage for one dependent.