This range is provided by Medix™. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.
Base pay range
$250,000.00/yr - $325,000.00/yr
A healthcare organization is seeking an experienced and hands‑on Chief Operating Officer (COO) 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.
- 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
- 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.
Seniority level: Executive
Employment type: Full‑time
Job function: Health Care Provider
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