Utilization Management Healthcare Operations Supervisor

Job description

Supervisor for Utilization Management Healthcare Operations Work Set-up: Onsite - Potential to WFH after training Location: Valero , Makati City Schedule: Graveyard | Shifting Hours Position Summary The US Healthcare Operations Supervisor oversees the daily operations of the provider-focused healthcare support team, ensuring authorization requests, referrals, provider communications, fax intake, and utilization management support activities are completed accurately, efficiently, and within established service level agreements (SLAs). This role serves as the primary operational lead for the assigned account, providing leadership, coaching, workload management, and performance oversight while partnering with clients, Quality Assurance, Training, Workforce Management, and Operations Leadership to drive operational excellence, compliance, and client satisfaction. The position is heavily focused on the provider side of healthcare operations , requiring strong knowledge of provider relations, prior authorization, referral management, managed care, and healthcare payer operations. The Supervisor is responsible for optimizing workflows, managing operational performance, mitigating risks, and ensuring successful service delivery. This is a non-clinical leadership position and does not involve medical necessity reviews, service approvals or denials, or any duties requiring clinical licensure. The ideal candidate has extensive experience in US Healthcare Operations , including provider support, prior authorization, utilization management, referral coordination, claims processing, and healthcare operations management. They possess proven leadership experience, strong client-facing skills, and a track record of driving performance, compliance, process improvements, and positive operational outcomes. Essential Duties & Responsibilities Team Leadership Supervise and lead the daily activities of Healthcare Operations Specialists, Prior Authorization Coordinators, Referral Coordinators, and provider support staff. Monitor attendance, productivity, quality, and schedule adherence to ensure operational goals are achieved. Conduct coaching sessions, performance evaluations, and development planning for direct reports. Provide ongoing mentorship, guidance, and support to team members. Foster a culture of accountability, collaboration, operational excellence, and continuous improvement. Support employee engagement, retention, and professional growth initiatives. Operations Management Oversee daily provider-facing healthcare operations, including prior authorization, referral coordination, provider communications, and utilization management support activities. Ensure timely and accurate processing of authorization requests, referrals, eligibility inquiries, and provider-related operational tasks. Monitor operational queues and workload distribution to maintain service level agreement (SLA) compliance. Manage staffing and resource allocation to support business demands and client expectations. Serve as the primary operational owner for assigned accounts, ensuring successful delivery of services. Identify, investigate, and resolve operational issues while escalating critical concerns appropriately. Coordinate with internal and external stakeholders to ensure seamless operational execution. Performance Management Monitor team and account-level KPIs, productivity, quality, and service delivery metrics. Analyze operational data, identify performance trends, and implement corrective action plans when necessary. Conduct regular one-on-one meetings and performance discussions with team members. Establish performance goals and expectations aligned with client and organizational objectives. Drive continuous improvement initiatives to enhance productivity, quality, and operational efficiency. Partner with Human Resources and leadership on performance management and employee relations matters. Quality & Compliance Ensure compliance with client requirements, healthcare regulations, company policies, and standard operating procedures. Partner with Quality Assurance teams to improve audit results and overall quality performance. Monitor adherence to documentation standards and operational workflows. Ensure HIPAA compliance and protection of confidential healthcare information. Support regulatory audits, client audits, and compliance reviews. Conduct root cause analyses and implement corrective actions to address quality or compliance gaps. Client & Cross-Functional Collaboration Serve as a primary operational point of contact for client stakeholders and internal leadership. Build and maintain strong relationships with providers, clients, and cross-functional business partners. Collaborate with Quality Assurance, Training, Workforce Management, and Operations Leadership to achieve business objectives. Communicate operational updates, risks, and performance results to stakeholders. Participate in client meetings, operational reviews, and business discussions as required. Support implementation of new processes, workflows, and client requirements. Reporting Prepare and present operational performance reports and business updates. Monitor and report productivity, quality, staffing, and SLA performance. Analyze trends and identify opportunities for process optimization and risk mitigation. Provide actionable recommendations to improve operational effectiveness and client satisfaction. Track account performance against established goals and contractual expectations. Process Improvement Identify and implement workflow optimization initiatives. Recommend process enhancements to improve efficiency, quality, and service delivery. Support implementation of new healthcare operations processes and client requirements. Lead or participate in operational improvement projects and special initiatives. Drive continuous improvement efforts focused on provider experience, operational performance, and client satisfaction. Required Qualifications High School Diploma required; Bachelor's Degree preferred. Minimum of 3 to 5 years of experience in US Healthcare Operations, Provider Services, Prior Authorization, Referral Management, Utilization Management Support, Claims, or Managed Care. Minimum of 2 years of supervisory, team lead, or people management experience. Strong understanding of healthcare payer operations, provider workflows, and managed care processes. Experience supporting provider-facing healthcare operations. Knowledge of medical terminology and healthcare regulatory requirements. Excellent leadership, coaching, communication, and stakeholder management skills. Strong analytical, organizational, problem-solving, and decision-making abilities. Experience managing KPIs, SLAs, productivity, and quality metrics. Proficiency in Microsoft Office applications, particularly Excel, Word, and PowerPoint. Preferred Experience US Healthcare Operations Provider Services Provider Relations Prior Authorization Referral Management Utilization Management Support Managed Care Medicare Medicaid Healthcare Operations Leadership Client-Facing Operations Workforce Management Performance Coaching KPI Management Quality Assurance Programs Process Improvement Initiatives Healthcare BPO Operations Key Performance Indicators (KPIs) Team Productivity Authorization Turnaround Time (TAT) Referral Processing Accuracy Queue Aging SLA Compliance Schedule Adherence Attendance Quality Audit Scores Authorization Accuracy Rate Provider Satisfaction Client Satisfaction Employee Engagement Employee Retention and Attrition Coaching Completion Rate Operational Risk Reduction Account Performance Achievement Service Delivery Effectiveness Process Improvement Implementation Success Work Arrangement & Remote Work Eligibility This position may require onsite presence during training, transition, new-hire nesting, team stabilization, client visits, performance-management activities, leadership meetings, or other operational needs. Healthcare Operations Supervisors may be eligible for a remote or hybrid work arrangement, subject to sustained operational performance, leadership effectiveness, team results, attendance, responsiveness, security, technology, client, and business requirements. Remote work eligibility is performance-based, role-dependent, and not guaranteed for the duration of employment. Supervisors must consistently demonstrate effective leadership and maintain required operational performance across assigned teams to remain eligible for remote or hybrid work. Continued remote-work eligibility will be evaluated based on team performance, quality, productivity, attendance, schedule adherence, service levels, compliance, provider experience, leadership effectiveness, responsiveness, and operational results. Failure to maintain required leadership, operational, compliance, or responsiveness standards may result in suspension of remote-work privileges and a requirement to return to the office. Eligibility to resume remote work will be based on demonstrated and sustained improvement in accordance with established operational guidelines. Supervisors must maintain a secure and appropriate remote-work environment, reliable internet connectivity, required equipment and technical standards, and full compliance with HIPAA, privacy, security, and client requirements. Remote Supervisors must remain available and responsive throughout scheduled working hours and attend all required meetings, leadership calls, coaching sessions, training, calibrations, client discussions, and other scheduled activities. Supervisors may be required to report to the office for training, coaching, performance management, system or security requirements, client requirements, leadership meetings, team needs, or other business needs. Additional Benefits: Comprehensive HMO Coverage - Medical & Dental HMO coverage on Day 1 plus 1 dependent About Imagenet Imagenet is a technology-forward healthcare operations partner with more than 25 years of experience helping healthcare payers manage critical administrative and operational processes. Founded in 2000 and headquartered in Tampa, Florida, Imagenet supports 150+ health plans through its payer clients. Our teams help improve efficiency, accuracy, visibility, and service across complex healthcare operations, including digital mailroom, claims adjudication, contact center, member communications, and related administrative functions. By combining experienced operational teams, proven processes, and purpose-built workflow technology, Imagenet helps payers keep essential processes moving for the members, providers, and communities they serve. Imagenet operates 10 secure facilities across the U.S. and one secure facility in Manila, Philippines. Joining Imagenet means contributing to work that supports the healthcare operations members and providers rely on every day.