AVP Healthcare Delivery

AVP for Healthcare Delivery

Role: AVP for Healthcare Delivery

Location:

Austin TX for D1 band. Onsite

Role Summary

The AVP – Healthcare Delivery is responsible for leading large-scale healthcare payer and provider operations, ensuring exceptional client outcomes, operational excellence, regulatory compliance, financial performance, and digital transformation. The role oversees multiple delivery portfolios, manages executive client relationships, drives operational improvements, and leads large global teams supporting healthcare business processes.

The AVP serves as a strategic partner to clients, ensuring achievement of contractual commitments, operational KPIs, quality standards, compliance requirements, and business growth objectives while leveraging automation, AI, and process transformation initiatives to enhance service delivery.

Key Responsibilities

Delivery & Operations Leadership

Lead end-to-end delivery for healthcare payer and provider operations across multiple accounts and service lines. Ensure achievement of all client SLAs, KPIs, contractual obligations, and regulatory requirements. Drive operational excellence, productivity improvement, and service quality initiatives. Establish robust governance frameworks including operational reviews, risk management, and escalation processes. Oversee operational readiness for business transitions, migrations, and transformation programs.

Healthcare Domain Leadership

Manage large healthcare operations including:

Claims Adjudication & Claims Operations Medicare & Medicaid Operations Provider Services & Provider Data Management Enrollment & Membership Services Care Management Support Utilization Management Support Prior Authorization Operations Appeals & Grievances Payment Integrity & Recovery Services Clinical Documentation & Coding Support Healthcare Contact Center Operations Client Relationship Management

Develop and maintain executive-level relationships with healthcare payer and provider clients. Lead Quarterly Business Reviews (QBRs), operational governance meetings, and strategic planning sessions. Provide proactive recommendations to improve operational efficiency, quality, compliance, and member/provider experience. Own executive communications for client escalations, operational risks, and strategic initiatives.

Financial & Business Management

Own delivery P&L for assigned healthcare accounts and portfolios. Manage revenue growth, gross margin improvement, productivity targets, and cost optimization initiatives. Develop business cases for transformation and automation investments. Support new business growth, solutioning, and account expansion opportunities.

Regulatory Compliance & Risk Management

Ensure compliance with CMS, HIPAA, NCQA, URAC, State Medicaid, and client-specific regulatory requirements. Lead audit readiness activities and support internal, external, and regulatory audits. Establish preventive controls to mitigate operational and compliance risks. Drive root cause analysis and corrective action programs for operational errors and client escalations.

Transformation & Innovation

Lead implementation of automation, AI, analytics, and digital transformation initiatives. Drive operational efficiency through workflow redesign, Lean Six Sigma, and continuous improvement practices. Sponsor innovation programs that improve member experience, provider satisfaction, quality, and cost outcomes. Identify opportunities for GenAI, intelligent automation, and healthcare process modernization.

People Leadership

Lead and develop a large healthcare operations organization. Build leadership succession pipelines and talent development programs. Drive employee engagement, retention, diversity, and capability-building initiatives. Mentor Delivery Directors, Operations Managers, and future leaders. Foster a culture of accountability, collaboration, and customer-centricity.

Qualifications

Education

Bachelor's degree in Healthcare Administration, Business Administration, Nursing, Life Sciences, or related field. MBA, MHA, MPH, or equivalent preferred.

Experience

15+ years of experience in Healthcare BPO, Healthcare Operations, or Managed Care Operations. Minimum 8+ years of leadership experience managing large healthcare operations. Demonstrated experience with Medicare, Medicaid, Commercial Health Plans, and Provider Operations. Experience managing multi-million-dollar P&L responsibilities. Proven track record leading global healthcare delivery organizations.