Associate Director - Medical Operations & Governance

MediCard Phils., Inc. is one of the country's leading HMO and the only HMO founded and run by Doctors. Since its inception, the concept of service-oriented total health care has been the molding ideal of MediCard.  The competition is vast, and the benefits being offered by the competitors are tempting.  However, MEDICard has taken the lead in providing innovative and productive ideas that cut down the cost of health maintenance without compromising its quality.

MediCard now boasts of more than half a million members and over 54,000 accredited doctors in over 1,000 hospitals and clinics nationwide. It also operates 16 MediCard free-standing clinics that provide services at par with those offered by hospitals minus the confinement.

MediCard is currently looking for assertive, dynamic and energetic individuals to fill up the following vacancy:

Provide enterprise medical leadership across Medicard’s health delivery, provider management, and medical governance functions. The role ensures clinically sound, cost-effective, and compliant medical decision-making across operations, claims utilization, and provider networks, while supporting sustainable business growth and member outcomes.

DUTIES & RESPONSIBILITIES
• Lead medical operations to ensure effective, efficient, and clinically appropriate health service delivery.
• Provide senior medical oversight on claims utilization, medical necessity reviews, and complex case escalations.
• Oversee provider performance, clinical quality, and compliance with Medicard standards.
• Develop, implement, and enforce medical policies, clinical guidelines, and governance frameworks.
• Lead Medical Capability and Medical Governance consultants in strengthening clinical standards.
• Provide medical leadership over utilization analytics and provider performance data.
• Partner with Claims, Health Services, Product, and Operations teams to ensure clinically sound decisions.
• Represent Medicard in medical governance discussions with providers, partners, and regulators as required.
KPIs• Claims utilization effectiveness and medical cost discipline
• Provider quality, performance, and compliance outcomes
• Timeliness and quality of medical reviews and escalations
• Reduction in inappropriate utilization and medical risk exposure
• Effectiveness of medical governance frameworks
• Stakeholder confidence in medical decisions

MINIMUM QUALIFICATIONS
• Licensed Medical Doctor
• Postgraduate training or significant experience in medical administration, utilization management, or managed care
Experience
• 10+ years in clinical practice, healthcare operations, managed care, or medical leadership roles
• Experience working with provider networks, claims, or utilization management
• Exposure to healthcare governance, medical policy development, or quality management

Core Competencies
• Strong clinical judgment with operational mindset
• Ability to balance quality of care with cost discipline
• Executive communication and stakeholder influence
• Data-informed medical decision-making
• High ethical and governance standards

At MediCard, we believe that diversity and inclusion are essential to fostering innovation, collaboration, and growth. We are committed to creating a workplace where everyone, regardless of gender, race, ethnicity, age, sexual orientation, disability, or any other characteristic, feels valued and empowered to contribute their unique perspectives and talents.

Our inclusive hiring practices ensure that we attract, hire, and retain the best talent from all backgrounds. We strive to provide equal opportunities for all candidates and promote a culture of respect, fairness, and transparency. We are dedicated to continuously improving our processes and policies to eliminate biases and barriers, ensuring that every employee has the support and resources they need to thrive.

MediCard is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
 
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