VP of Operations - 247205

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