Director Of Operation- Bakersfield 1.1

Universal Healthcare MSO•Bakersfield, CA

2d•Onsite

About The Position

The Director of Operations is responsible for providing strategic and operational leadership across multiple core business functions within Universal Healthcare MSO, including Claims, Customer Service and Appeals & Grievances (A&G), Network Management (Contracting and Credentialing), Enrollment, and Payroll support operations. This position oversees departmental performance, operational efficiency, regulatory compliance, and cross-functional collaboration to ensure organizational goals, service standards, and compliance obligations are consistently achieved. The Director of Operations plays a critical leadership role in driving operational excellence, supporting organizational growth initiatives, improving workflows, and developing high-performing teams across multiple operational departments. This role partners closely with Executive Leadership to implement strategic initiatives, monitor key operational metrics, support CMS and regulatory readiness, and ensure departments maintain effective processes that support members, providers, employer groups, and internal stakeholders. This position is responsible for fostering a culture of accountability, collaboration, customer service excellence, compliance, and continuous improvement while ensuring operational areas function efficiently, accurately, and in alignment with UHC MSO’s mission, values, and business objectives.

Requirements

Bachelor’s degree in Healthcare Administration, Business Administration, Public Health, or a related field preferred. Equivalent combination of education and experience may be considered.
Minimum of 7 years of progressive healthcare operations experience required.
Minimum of 3–5 years of leadership experience managing operational teams and/or multiple departments required.
Experience within managed care, Medicare Advantage, Medi-Cal, MSO, IPA, or health plan operations strongly preferred.
Experience overseeing operational areas such as Claims, Customer Service, Appeals & Grievances, Enrollment, Credentialing, Contracting, and/or Provider Operations preferred.
Experience supporting payroll processes or operational payroll functions required.
Strong knowledge of healthcare operations, managed care processes, and regulatory requirements.
Understanding of CMS, DMHC, DHCS, HIPAA, and other applicable healthcare regulations preferred.
Strong leadership, organizational, and operational management skills.
Demonstrated ability to analyze operational metrics, identify trends, and implement process improvements.
Ability to manage multiple priorities and operational areas in a fast-paced environment.
Excellent communication, interpersonal, and conflict resolution skills.
Strong problem-solving and decision-making abilities.
Proficient in Microsoft Office applications and operational reporting tools.
Ability to maintain confidentiality and exercise sound judgment in handling sensitive information.

Nice To Haves

Experience within managed care, Medicare Advantage, Medi-Cal, MSO, IPA, or health plan operations strongly preferred.
Experience overseeing operational areas such as Claims, Customer Service, Appeals & Grievances, Enrollment, Credentialing, Contracting, and/or Provider Operations preferred.
Understanding of CMS, DMHC, DHCS, HIPAA, and other applicable healthcare regulations preferred.

Responsibilities

Provide leadership and operational oversight for Claims, Customer Service, Appeals & Grievances, Enrollment, Contracting, Credentialing, and Payroll support functions.
Develop and implement operational strategies that improve efficiency, productivity, accuracy, and service delivery across departments.
Partner with Executive Leadership to support organizational initiatives, operational planning, and long-term departmental growth strategies.
Monitor departmental performance metrics, identify trends, and implement corrective action plans or process improvements as needed.
Establish and maintain operational workflows, policies, procedures, and internal controls to support efficiency and compliance.
Promote collaboration and communication across departments to improve workflow integration and organizational effectiveness.
Support organizational readiness for audits, regulatory reviews, and compliance initiatives.
Assist with operational implementations, system enhancements, and process improvement initiatives impacting multiple departments.
Oversee Claims operations to ensure timely, accurate, and compliant claims adjudication and processing.
Monitor production, quality, turnaround times, and operational efficiencies within the Claims department.
Collaborate with Enrollment, Configuration, and other operational areas to support accurate claims processing and system integrity.
Review operational reports and trends to identify opportunities for workflow improvements and enhanced productivity.
Oversee Customer Service and A&G operations to ensure high-quality service and timely resolution of member and provider concerns.
Support departmental performance related to customer satisfaction, call center metrics, regulatory turnaround times, and operational goals.
Ensure compliance with CMS, Medi-Cal, health plan, and organizational service standards where applicable.
Partner with leadership staff to address escalated operational concerns and improve service delivery processes.
Monitor departmental trends and support initiatives that improve member and provider experience.
Provide operational oversight of provider contracting, credentialing, and network maintenance activities.
Support network development initiatives to ensure provider network adequacy and compliance with regulatory and contractual requirements.
Oversee processes related to provider onboarding, credentialing timelines, recredentialing, and provider data maintenance.
Collaborate with internal departments and external partners to support provider operations and maintain accurate provider information.
Oversee enrollment operations to ensure accurate and timely processing of membership transactions and eligibility maintenance.
Ensure enrollment activities comply with CMS, state, health plan, and organizational requirements where applicable.
Monitor reconciliation processes, audit readiness activities, reporting functions, and data integrity initiatives.
Support workflow improvements that enhance enrollment accuracy, efficiency, and operational effectiveness.
Provide operational support related to payroll processing activities in coordination with Human Resources and Finance departments.
Assist with payroll review processes to support timely and accurate payroll submissions.
Support payroll-related operational workflows, reporting, and issue resolution as needed.
Maintain confidentiality of employee payroll and organizational information.
Provide leadership, mentorship, and performance management support to managers, supervisors, and operational staff.
Foster a positive and accountable work environment focused on teamwork, professional development, and operational excellence.
Support employee engagement, coaching, training, and succession planning initiatives.
Participate in recruitment, interviewing, onboarding, corrective action, and performance evaluation processes for operational leadership staff.
Ensure operational departments maintain compliance with applicable CMS, DMHC, DHCS, HIPAA, health plan, and organizational requirements where applicable.
Support audit preparation, corrective action initiatives, and regulatory response activities.
Maintain knowledge of healthcare operational standards, regulatory changes, and industry best practices impacting operational departments.
Promote compliance awareness and accountability throughout operational teams.