Utilization Management Healthcare Operations Team Leader

Team Leader 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 Utilization Management Operations Team Leader is responsible for leading the day-to-day operations of the Utilization Management administrative support team. This role provides frontline leadership, coaching, workload coordination, and performance support to ensure authorization requests, referrals, fax intake, and administrative utilization management activities are completed accurately, efficiently, and within established service level agreements.

The Team Leader works closely with Quality Assurance, Training, Workforce Management, and Operations Leadership to support operational goals, service delivery, and compliance with client policies and regulatory requirements.

This is a non-clinical leadership position. The Team Leader does not perform medical necessity reviews, approve or deny services, or perform duties requiring clinical licensure.

The ideal candidate possesses experience in US Healthcare Operations, with exposure to claims processing, provider and member support, process improvement, quality compliance, and team leadership. They demonstrate the ability to guide team performance, support operational objectives, and drive continuous improvement while ensuring compliance with healthcare policies and procedures.

Essential Duties & Responsibilities

Team Leadership

• Lead the daily activities of UM Coordinators and support staff.
• Monitor attendance, productivity, and schedule adherence.
• Conduct coaching sessions and provide ongoing feedback.
• Provide guidance, mentorship, and support to team members.
• Promote employee engagement, accountability, and teamwork.

Operations Management

• Monitor authorization queues and workload distribution.
• Ensure timely processing of authorization and referral requests.
• Support turnaround time (TAT) compliance and service delivery goals.
• Coordinate with leadership regarding staffing and coverage needs.
• Escalate operational and workflow concerns as needed.

Performance Management

• Track team KPIs and productivity metrics.
• Identify performance trends and opportunities for improvement.
• Assist in developing action plans to improve team performance.
• Conduct regular one-on-one discussions with team members.
• Support performance management initiatives in partnership with leadership and HR.

Quality & Compliance

• Ensure adherence to SOPs, client requirements, and regulatory standards.
• Partner with QA to improve quality performance.
• Monitor documentation accuracy and compliance.
• Support audit preparation and readiness activities.
• Reinforce HIPAA and data privacy compliance.

Client & Cross-Functional Collaboration

• Coordinate with licensed clinical teams regarding operational workflow concerns.
• Partner with Training to support onboarding and staff development.
• Work closely with Workforce Management to address staffing and scheduling needs.
• Communicate operational updates to leadership.
• Participate in internal and client meetings as required.

Reporting

• Assist in preparing operational reports and performance updates.
• Monitor service levels and turnaround times.
• Track productivity and quality metrics.
• Identify operational risks and recommend corrective actions.

Process Improvement

• Support workflow optimization initiatives.
• Recommend operational improvements to increase efficiency and quality.
• Assist in implementing new client processes and procedures.
• Participate in special projects and continuous improvement activities.

Required Qualifications

• High School Diploma required; Bachelors Degree preferred.
• Minimum of 3-5 years of experience in healthcare operations, utilization management, prior authorization, claims, provider services, member services, or managed care.
• Minimum of 1 year of Team Leader, Lead, SME, Escalation Lead, or people leadership experience.
• Strong understanding of healthcare payer operations.
• Working knowledge of medical terminology.
• Strong leadership, coaching, and communication skills.
• Strong analytical, organizational, and problem-solving abilities.
• Intermediate to advanced Microsoft Office skills.

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.