Morgan Consulting Resources, Inc.
Vice President of Operations
Morgan Consulting Resources, Inc., Houston, Texas, United States, 77246
Morgan Consulting Resources, Inc. has been retained to confidentially search for a
Vice President, Operations
for a Texas Department licensed Third Party Administrator (TPA) and Management Service Organization (MSO). This position will work on-site in Houston, TX four (4) days a week to start with the opportunity to transition to a hybrid schedule once established in the role.
About the Company We are directly contracted with Fortune 100 and other National health plans for Medicare Advantage. Our primary operating model is leading full-risk value based models which allows us to serve the best interest of our members and providers. Our model is designed to advance the best interests of both members and providers by enabling high-quality, coordinated, and financially aligned care. Through our administrative and clinical infrastructure, providers gain more time to support the complex needs of their patients, participate in robust pay-for-quality programs, and work directly with us rather than navigating multiple health plans.
We deliver a comprehensive suite of services in accordance with regulations established by the Centers for Medicare & Medicaid Services (CMS) and standards set by the National Committee for Quality Assurance (NCQA), including: regulatory compliance, claims processing and payment operations, provider credentialing, financial services, revenue cycle management, network management and performance improvement, including population health management, HEDIS/quality improvement, and enhanced value based care initiatives.
About the Position Reporting to the President, the Vice President of Operations (“VP”) will provide strategic and operational leadership across the Management Services Organization (MSO) supporting Medicare Advantage products, value-based care networks and cost containment under global (Part C) Medicare Advantage risk arrangements. The organization will be expanding into Traditional Medicare, Medicaid and Commercial VBC programs.
This position drives operational excellence, regulatory compliance, and performance optimization across core MSO functions including claims administration, medical management, provider network operations, quality/STAR programs, member engagement, call center, and technology integration.
Experience in claims operations oversight is essential, driving accuracy, timeliness, compliance, monitoring, and effective coordination across delegated functions.
This leader will also be responsible for technology adoption among managed providers to achieve greater interoperability, data transparency, and workflow efficiency that drive operational excellence and quality outcomes.
The VP plays a pivotal role in translating strategy into execution, driving cross-departmental collaboration, and ensuring the organization’s infrastructure supports sustainable growth, financial performance, and superior member and provider outcomes.
Essential Functions
Operational Leadership
Medical Management Oversight
Financial and Performance Management
Provider Network & Relations
Quality, Compliance & Risk Adjustment
Organizational Leadership
Required Qualifications
Bachelor’s degree in Healthcare Administration, Business, or related field; Masters degree preferred.
Minimum five (5) years of progressive leadership experience in healthcare operations, with at least three (3) years in Medicare Advantage, global risk, and delegated MSO settings.
Demonstrated expertise in: CMS Part C operations and compliance, Utilization and Care Management programs, Claims and encounter data integrity, Quality/STARs performance improvement, and Revenue Cycle Management/Risk adjustment and documentation for diagnosis capture/recapture.
Strong financial acumen and understanding of PMPM, MLR, and EBITDA drivers.
Proven success leading cross-functional teams in complex, regulated environments.
Excellent communication, analytical, and organizational skills.
Ability to collaborate effectively with physicians, health plans, and regulatory agencies.
Organization Culture & Values
We foster a collaborative, inclusive, and performance-driven culture built on respect, accountability, and innovation. This role is expected to exemplify these values and inspire operational excellence across all departments.
This position, along with team members within assigned units and across the organization, fosters an engaging and professional environment committed to respect, inclusivity, continuous improvement, and teamwork.
The position works within policies and procedures, related to the department and organization, and supports efforts needed for organizational growth, proposal developments, fiscal management, and monitoring, reporting and analysis, and supports compliance with local, state, and federal regulations as well as regulatory, controlling, and licensing agencies.
We provide equal access to and opportunity within the organization and employment, without regard to race, color, creed, religion, national origin, gender, age, marital status, disability, public assistance status, veteran status, sexual orientation, gender identity, or gender expression.
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Vice President, Operations
for a Texas Department licensed Third Party Administrator (TPA) and Management Service Organization (MSO). This position will work on-site in Houston, TX four (4) days a week to start with the opportunity to transition to a hybrid schedule once established in the role.
About the Company We are directly contracted with Fortune 100 and other National health plans for Medicare Advantage. Our primary operating model is leading full-risk value based models which allows us to serve the best interest of our members and providers. Our model is designed to advance the best interests of both members and providers by enabling high-quality, coordinated, and financially aligned care. Through our administrative and clinical infrastructure, providers gain more time to support the complex needs of their patients, participate in robust pay-for-quality programs, and work directly with us rather than navigating multiple health plans.
We deliver a comprehensive suite of services in accordance with regulations established by the Centers for Medicare & Medicaid Services (CMS) and standards set by the National Committee for Quality Assurance (NCQA), including: regulatory compliance, claims processing and payment operations, provider credentialing, financial services, revenue cycle management, network management and performance improvement, including population health management, HEDIS/quality improvement, and enhanced value based care initiatives.
About the Position Reporting to the President, the Vice President of Operations (“VP”) will provide strategic and operational leadership across the Management Services Organization (MSO) supporting Medicare Advantage products, value-based care networks and cost containment under global (Part C) Medicare Advantage risk arrangements. The organization will be expanding into Traditional Medicare, Medicaid and Commercial VBC programs.
This position drives operational excellence, regulatory compliance, and performance optimization across core MSO functions including claims administration, medical management, provider network operations, quality/STAR programs, member engagement, call center, and technology integration.
Experience in claims operations oversight is essential, driving accuracy, timeliness, compliance, monitoring, and effective coordination across delegated functions.
This leader will also be responsible for technology adoption among managed providers to achieve greater interoperability, data transparency, and workflow efficiency that drive operational excellence and quality outcomes.
The VP plays a pivotal role in translating strategy into execution, driving cross-departmental collaboration, and ensuring the organization’s infrastructure supports sustainable growth, financial performance, and superior member and provider outcomes.
Essential Functions
Operational Leadership
Medical Management Oversight
Financial and Performance Management
Provider Network & Relations
Quality, Compliance & Risk Adjustment
Organizational Leadership
Required Qualifications
Bachelor’s degree in Healthcare Administration, Business, or related field; Masters degree preferred.
Minimum five (5) years of progressive leadership experience in healthcare operations, with at least three (3) years in Medicare Advantage, global risk, and delegated MSO settings.
Demonstrated expertise in: CMS Part C operations and compliance, Utilization and Care Management programs, Claims and encounter data integrity, Quality/STARs performance improvement, and Revenue Cycle Management/Risk adjustment and documentation for diagnosis capture/recapture.
Strong financial acumen and understanding of PMPM, MLR, and EBITDA drivers.
Proven success leading cross-functional teams in complex, regulated environments.
Excellent communication, analytical, and organizational skills.
Ability to collaborate effectively with physicians, health plans, and regulatory agencies.
Organization Culture & Values
We foster a collaborative, inclusive, and performance-driven culture built on respect, accountability, and innovation. This role is expected to exemplify these values and inspire operational excellence across all departments.
This position, along with team members within assigned units and across the organization, fosters an engaging and professional environment committed to respect, inclusivity, continuous improvement, and teamwork.
The position works within policies and procedures, related to the department and organization, and supports efforts needed for organizational growth, proposal developments, fiscal management, and monitoring, reporting and analysis, and supports compliance with local, state, and federal regulations as well as regulatory, controlling, and licensing agencies.
We provide equal access to and opportunity within the organization and employment, without regard to race, color, creed, religion, national origin, gender, age, marital status, disability, public assistance status, veteran status, sexual orientation, gender identity, or gender expression.
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