COO

Position: COO - 247205
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

$/yr - $/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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