Overview

A healthcare organization is seeking an experienced and hands-on VP of Operations to lead operations, compliance, and network development. This role is ideal for a leader with strong operational and regulatory expertise in managed care, including familiarity with DMHC, CMS, and delegated oversight requirements. The COO will play a critical role in guiding the organization from regulatory readiness to sustained operational excellence.

Key Responsibilities

Operational Leadership & Strategy

Oversee daily operations including claims, member services, enrollment, provider relations, and delegation oversight.
Lead operational readiness activities for DMHC and CMS approvals, ensuring compliance with all regulatory filings and standards.
Develop and implement operational policies, procedures, and performance metrics to ensure efficiency and service quality.
Collaborate with shared service teams such as finance, IT, HR, and compliance to streamline processes and optimize resources.

Network & Market Development

Build and manage a provider network that meets regulatory adequacy standards and supports value-based care models.
Negotiate and manage contracts with hospitals, physician groups, and ancillary providers.
Foster collaborative relationships with provider groups, IPAs, MSOs, and community partners.

Compliance & Quality Management

Partner with compliance leadership to ensure operational adherence to DMHC and CMS regulations.
Lead audit readiness, encounter data accuracy, and oversight of delegated entities.
Support quality initiatives, including HEDIS, CAHPS, and STARs programs, to enhance plan performance.

Financial & Administrative Oversight

Work with finance leadership to monitor budgets, fiscal soundness (TNE), and vendor performance.
Identify opportunities to improve administrative efficiency and control costs.

People & Culture

Build and mentor a collaborative and high-performing operations team.
Foster a culture of accountability, transparency, and service excellence.

Qualifications

Medicare Advantage experience and Operations leadership in Member Services, A&G, Enrollment, and Compliance required.
Master’s degree in Healthcare Administration, Business, or related field preferred.
12–15 years of experience in healthcare or managed care operations, including at least 7 years in a senior leadership role.
Strong understanding of DMHC licensing, CMS contracting, and delegated oversight models.
Proven ability to lead organizations through growth, start-up, or turnaround phases.
Excellent analytical, financial, and problem-solving skills.
Hands-on leadership style with the ability to balance strategic planning and daily execution.

Pay: $250 - $325K in total comp, includes salary and bonuses

Medix™

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