Vice President of Operations

Nonprofit

Published 16 days ago

Vice President of Operations

Santa Clara Family Health Plan

Hybrid, Work must be performed in or near San Jose, CA

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Details

Job Type:

Full Time

Education:

4-Year Degree Required

Experience Level:

Executive

Salary:

USD $254,696 - $331,105 / year

Description

About Us:

Santa Clara Family Health Plan (SCFHP) is a local, community-based health plan dedicated to improving the health and well-being of the residents of Santa Clara County. Working in partnership with providers and community organizations, we serve our neighbors through our Medi-Cal and SCFHP DualConnect (HMO D-SNP) health care plans.

About The Role:

The Vice President, Operations is a senior executive leader responsible for ensuring strategic alignment, regulatory adherence, operational excellence, and a culture of continuous improvement of core health plan operations (enrollment and eligibility, customer service, grievances and appeals, and vendor management). In this role, the Vice President, Operations holds organizational accountability for regulatory and audit oversight, technology enablement, member experience, and leadership and talent development, and represents SCFHP externally with business partners, delegates, and regulators.

Day To Day:

• Provide strategic oversight and executive accountability for Enrollment and Eligibility, Customer Service, Grievances and Appeals, and Vendor Management, ensuring each functional area meets performance, compliance, and service quality standards.
• Provide oversight and direction to the Director, Operations to ensure effective and compliant Enrollment and Eligibility and Grievances and Appeals operations, including root cause analysis, regulatory reporting, and improvement initiatives.
• Provide oversight and direction to the Director, Customer Service to ensure department operations deliver a consistent, high-quality member and provider service experience, including transportation coordination and escalation resolution.
• Maintain organizational accountability for Vendor Management; establish and sustain vendor strategy, contract lifecycle standards, and performance frameworks in coordination with business unit leads, Compliance and legal counsel.
• Work with departmental leadership to develop and monitor individual objectives and departmental budgets across all areas of responsibility, reviewing performance regularly and ensuring responsible resource management.
• Lead interdepartmental initiatives with clear objectives, deliverables, timelines, and success metrics.
• Maintain current knowledge of federal and state regulations governing health plan operations, including DHCS and CMS requirements, APLs, DPLs, and Medicare Managed Care Manual provisions; ensure these requirements are translated into operational policies, procedures, and reporting standards across all supervised functions.
• Represent SCFHP in external regulatory meetings and compliance audits, oversee identification and remediation of compliance gaps, and ensure timely corrective action across operational departments.
• Champion a culture of continuous improvement across all operational areas; identify and sponsor workflow optimization and process improvement initiatives to drive efficiency, accuracy, and quality.
• Provide oversight for system technology implementation, including evaluation of technology investments and operational enhancements; maintain performance dashboards and reporting frameworks to support data-informed decision-making.
• Champion the member experience as a strategic priority; analyze trends across grievances and appeals, customer service data, and member feedback to identify systemic gaps and oversee interventions that reflect SCFHP’s commitment to accessibility, equity, and service excellence.
• Represent SCFHP externally with providers, delegates, community stakeholders, and regulators; collaborate with internal departments on communications and resources that support member and provider understanding of health plan services.
  
  

About You:

• Bachelor’s Degree in Healthcare Administration, Business Administration, Public Administration, or a related field; or equivalent experience.
• Master’s Degree in Healthcare Administration, Business Administration, Public Administration. (Desired)
• Minimum of ten years of senior-level managed care leadership experience, including significant exposure to enrollment and eligibility, grievances and appeals, customer service/contact center operations, and/or provider network management.
• Demonstrated experience in Medi-Cal and/or Medicare health plan operations, with working knowledge of how operational performance influences Medicare Star Ratings, HEDIS measures, and regional healthcare market dynamics.
• Deep understanding of health plan regulatory requirements, including DHCS and CMS standards, APLs, DPLs, and managed care compliance, with strong command of appeals and
  
  

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Benefits

Benefits

Santa Clara Family Health Plan (SCFHP) Is a Nonprofit Organization With a Long History Of Caring For The Health Of Our Community. And We Take The Health And Well-being Of Our Employees Just As Seriously. We're Proud To Be One Of The Top Providers Of Healthcare Jobs In Santa Clara County, With Ample Benefits And Opportunities For Advancement. These Include:

• Competitive wages. We keep track of the current market and local economy to offer our employees competitive pay ranges, regular increases, and longevity bonuses.
• Comprehensive health insurance, including vision and dental coverage. Employees have their choice of medical plans through the California Public Employees' Retirement System (CalPERS).
• Other insurance. We offer life insurance, accidental death and dismemberment insurance, and long-term disability insurance.
• Generous paid time off—with cash-out and carry-over options. We want our employees to have time to rest, relax, and grow outside of work. Paid time off increases with longevity and starts at 18 days per year for regular employees.
• Flexible spending accounts. This includes optional pretax accounts for healthcare, dependent care, and transit and parking.
• Retirement benefits. Benefits are made up of four different programs: CalPERS Pension Plan, 401A Discretionary Plan, 401A Supplemental PEPRA Plan, and an optional 457 deferred compensation plan.
• Union representation. Certain positions are represented by the Service Employees International Union.
• Wellness perks. Health isn't just for outside the workplace. We strive to maintain a thriving work environment with standing work stations, an on-site gym, and a low-cost farmers market. We also offer free, confidential counseling 24 hours a day, 7 days a week through our employee assistance program.
• Financial services. Employees of SCFHP get help investing wisely and planning for the future through financial planning, investment counseling, and retirement planning workshops. Employees also have the opportunity to join the County Federal Credit Union.
• Travel and education. To help our employees expand their horizons, we offer tuition reimbursement for continued education and development. We also offer discounts on certain hotels and cell phone plans, as well as emergency travel assistance via the TravelConnect program.
  

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Location

Hybrid

Work must be performed in or near San Jose, CA

Associated Location

6201 San Ignacio Ave, San Jose, CA 95119, USA

How to Apply

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