Gold Coast Health Plan
Overview Join to apply for the
Chief Operating Officer
role at
Gold Coast Health Plan . The COO is a member of the executive management team and reports directly to the Chief Executive Officer (CEO). The COO is responsible for the overall operational performance of the enterprise and to ensure a well-run, operationally capable organization. The COO provides leadership and oversight of core health plan operations, such as Claims Management, Member Grievance and Appeals, Provider Operations and Services, Member and Provider Contact Center Services, and Provider Contract Management. Additional areas include Operational Assurance and Enterprise Data, Analytics and Insights. This position has overall responsibility for policy development, program planning, fiscal management, administration and operation of assigned Plan functions, programs and activities. The position assists the CEO and executive team in developing and implementing the organization’s strategic plan and related goals.
Any additional information you require for this job can be found in the below text Make sure to read thoroughly, then apply. Amount of Travel Required: 10% as needed Work Schedule: Hybrid work environment with protracted and irregular hours and evening meetings or irregular hours for attendance at meetings for special projects and programs. Disclaimers
Flexible work schedule is based on job duties, department, organization, or business need. Gold Coast Health Plan will not sponsor applicants for work visas. Core Values
Integrity Accountability Collaboration Trust Respect Essential Functions
Lead strategic planning and program development for the Operations organization. Lead and ensure effective operations of core operations functions. Internal staff and departments are provided with direction and support to fulfill their functions. Lead the operations to achieve the targeted key performance indicators. Establish and maintain appropriate procedures and controls to ensure accuracy. Analyze and recommend changes in organizational systems, policies and procedures to improve organizational performance and achieve regulatory compliance. Establish policies and guidelines for operational excellence and regulatory compliance. Be fully compliant with regulatory requirements. Policies, procedures and guidelines are created and regularly reviewed for operational excellence. Primary areas of responsibility include Claims Management, Member Grievance and Appeals, Provider Operations and Services, Member and Provider Contact Center Services, and Provider Contract Management and Enterprise Data, Analytics and Insights. Accountable for all outsourced services and related third-party vendor relations to ensure targeted outcomes are delivered and achieved. Manages budgets of assigned departments and ensures compliance of each area with current state and federal laws and regulations. Initiate, implement and review activities to advance quality, improve member, provider and employee satisfaction, reduce expenses and increase staff productivity. Responsible for reporting and analysis in achievement of department goals. Collaborate with internal and external customers and stakeholders to resolve issues and enhance relationships. Ensure the organization and its mission, programs and services are consistently presented in a strong, positive image to relevant stakeholders. The position assists the CEO in implementing the organization’s strategic goals. Minimum Qualifications
Bachelor's Degree (four-year college) Required. Field of Study: in an appropriate discipline. 8+ years of progressively responsible experience in managed healthcare leadership, with previous executive leadership experience reporting to a CEO level in a similar type of organization. 8+ years of experience in management leadership. Proven success with challenging work in a complex organizational structure. Managing a P&L and delivering results is critical. Experience with outside regulators, governmental entities, etc. Strong business and managed care acumen with a demonstrable record of achieving net results. Proven strategic thinker and planner with strong communication skills who can motivate others. Proven execution against aggressive objectives. Strong organizational leadership, administration, analytical, negotiation and financial management skills. Excellent communication - written, verbal and interpersonal skills. Proven ability to develop and maintain strong business relationships. Experienced policy development, program planning, fiscal management, administration and operation of assigned Plan functions, programs and activities. Preferred Qualifications
Master's Degree Preferred. Field of Study: Business, Healthcare or Public Administration is preferred. Experience working within a matrix management structure is preferred. Knowledge of Medi-Cal and Medicare is preferred. Knowledge, Skills & Abilities
Technology & Software Skills: Advanced computer skills in MS Office products. Certifications & Licenses: A valid and current Driver's License, Auto Insurance, and professional licensure(s). Competencies
Management Skills - Ability to organize and direct oneself and effectively supervise others. Business Acumen - Ability to grasp and understand business concepts and issues. Decision Making - Ability to make critical decisions while following company procedures. Goal Oriented - Ability to focus on a goal and obtain a pre-determined result. Cultural Alignment – Ability to think and act within a Community-based, Mission-driven culture focused on connecting Member with quality care. Interpersonal - Ability to get along well with a variety of personalities and individuals. Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type. Time Management - Ability to utilize the available time to organize and complete work within given deadlines. Consensus Building - Ability to bring about group solidarity to achieve a goal. Relationship Building - Ability to effectively build relationships with customers and co-workers. Presentation Skills - Ability to effectively present information publicly. Delegating Responsibility - Ability to allocate authority and/or task responsibility to appropriate people. Leadership - Ability to influence others to perform their jobs effectively and to be responsible for making decisions. Strategic Planning - Ability to develop a vision for the future and create a culture in which the long-range goals can be achieved. Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards. Judgment - The ability to formulate a sound decision using the available information. Communication, Oral - Ability to communicate effectively with others using the spoken word. Communication, Written - Ability to communicate in writing clearly and concisely. Problem Solving - Ability to find a solution for or to deal proactively with work-related problems. Seniority level
Executive Employment type
Full-time Job function
Management and Manufacturing Industries
Hospitals and Health Care
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Chief Operating Officer
role at
Gold Coast Health Plan . The COO is a member of the executive management team and reports directly to the Chief Executive Officer (CEO). The COO is responsible for the overall operational performance of the enterprise and to ensure a well-run, operationally capable organization. The COO provides leadership and oversight of core health plan operations, such as Claims Management, Member Grievance and Appeals, Provider Operations and Services, Member and Provider Contact Center Services, and Provider Contract Management. Additional areas include Operational Assurance and Enterprise Data, Analytics and Insights. This position has overall responsibility for policy development, program planning, fiscal management, administration and operation of assigned Plan functions, programs and activities. The position assists the CEO and executive team in developing and implementing the organization’s strategic plan and related goals.
Any additional information you require for this job can be found in the below text Make sure to read thoroughly, then apply. Amount of Travel Required: 10% as needed Work Schedule: Hybrid work environment with protracted and irregular hours and evening meetings or irregular hours for attendance at meetings for special projects and programs. Disclaimers
Flexible work schedule is based on job duties, department, organization, or business need. Gold Coast Health Plan will not sponsor applicants for work visas. Core Values
Integrity Accountability Collaboration Trust Respect Essential Functions
Lead strategic planning and program development for the Operations organization. Lead and ensure effective operations of core operations functions. Internal staff and departments are provided with direction and support to fulfill their functions. Lead the operations to achieve the targeted key performance indicators. Establish and maintain appropriate procedures and controls to ensure accuracy. Analyze and recommend changes in organizational systems, policies and procedures to improve organizational performance and achieve regulatory compliance. Establish policies and guidelines for operational excellence and regulatory compliance. Be fully compliant with regulatory requirements. Policies, procedures and guidelines are created and regularly reviewed for operational excellence. Primary areas of responsibility include Claims Management, Member Grievance and Appeals, Provider Operations and Services, Member and Provider Contact Center Services, and Provider Contract Management and Enterprise Data, Analytics and Insights. Accountable for all outsourced services and related third-party vendor relations to ensure targeted outcomes are delivered and achieved. Manages budgets of assigned departments and ensures compliance of each area with current state and federal laws and regulations. Initiate, implement and review activities to advance quality, improve member, provider and employee satisfaction, reduce expenses and increase staff productivity. Responsible for reporting and analysis in achievement of department goals. Collaborate with internal and external customers and stakeholders to resolve issues and enhance relationships. Ensure the organization and its mission, programs and services are consistently presented in a strong, positive image to relevant stakeholders. The position assists the CEO in implementing the organization’s strategic goals. Minimum Qualifications
Bachelor's Degree (four-year college) Required. Field of Study: in an appropriate discipline. 8+ years of progressively responsible experience in managed healthcare leadership, with previous executive leadership experience reporting to a CEO level in a similar type of organization. 8+ years of experience in management leadership. Proven success with challenging work in a complex organizational structure. Managing a P&L and delivering results is critical. Experience with outside regulators, governmental entities, etc. Strong business and managed care acumen with a demonstrable record of achieving net results. Proven strategic thinker and planner with strong communication skills who can motivate others. Proven execution against aggressive objectives. Strong organizational leadership, administration, analytical, negotiation and financial management skills. Excellent communication - written, verbal and interpersonal skills. Proven ability to develop and maintain strong business relationships. Experienced policy development, program planning, fiscal management, administration and operation of assigned Plan functions, programs and activities. Preferred Qualifications
Master's Degree Preferred. Field of Study: Business, Healthcare or Public Administration is preferred. Experience working within a matrix management structure is preferred. Knowledge of Medi-Cal and Medicare is preferred. Knowledge, Skills & Abilities
Technology & Software Skills: Advanced computer skills in MS Office products. Certifications & Licenses: A valid and current Driver's License, Auto Insurance, and professional licensure(s). Competencies
Management Skills - Ability to organize and direct oneself and effectively supervise others. Business Acumen - Ability to grasp and understand business concepts and issues. Decision Making - Ability to make critical decisions while following company procedures. Goal Oriented - Ability to focus on a goal and obtain a pre-determined result. Cultural Alignment – Ability to think and act within a Community-based, Mission-driven culture focused on connecting Member with quality care. Interpersonal - Ability to get along well with a variety of personalities and individuals. Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type. Time Management - Ability to utilize the available time to organize and complete work within given deadlines. Consensus Building - Ability to bring about group solidarity to achieve a goal. Relationship Building - Ability to effectively build relationships with customers and co-workers. Presentation Skills - Ability to effectively present information publicly. Delegating Responsibility - Ability to allocate authority and/or task responsibility to appropriate people. Leadership - Ability to influence others to perform their jobs effectively and to be responsible for making decisions. Strategic Planning - Ability to develop a vision for the future and create a culture in which the long-range goals can be achieved. Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards. Judgment - The ability to formulate a sound decision using the available information. Communication, Oral - Ability to communicate effectively with others using the spoken word. Communication, Written - Ability to communicate in writing clearly and concisely. Problem Solving - Ability to find a solution for or to deal proactively with work-related problems. Seniority level
Executive Employment type
Full-time Job function
Management and Manufacturing Industries
Hospitals and Health Care
#J-18808-Ljbffr