Medix™
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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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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