VP of Operations

Location : This•Huntington Beach, CA

16h•Onsite

About The Position

The Vice President of Operations is a senior executive responsible for leading and optimizing health plan operations across Medicare Advantage, Medicaid Managed Care, Commercial, and Integrated Delivery Network lines of business. This position provides strategic direction and operational leadership to support exceptional service delivery, regulatory compliance, quality outcomes, positive member and provider experiences, and responsible financial management. Working closely with executive leadership, the Vice President of Operations will develop and execute operational strategies that support organizational growth, population health objectives, value-based care initiatives, and evolving regulatory requirements. This position oversees critical operational functions and drives continuous improvement through innovation, technology, workforce development, and data-driven decision-making.

Requirements

A bachelor's degree in Healthcare Administration, Business Administration, Public Health, or a related field.
At least 10 years of progressive leadership experience within managed care, health insurance, provider-sponsored health plans, or integrated healthcare organizations.
Demonstrated experience leading Medicare Advantage, Medicaid, Commercial, and/or Integrated Delivery Network operations.
Extensive knowledge of CMS regulations, state Medicaid requirements, NCQA standards, and healthcare operational best practices.
Proven success in operational transformation, process improvement, and large-scale team leadership.
Strong analytical, financial, strategic-planning, and stakeholder-management capabilities.

Nice To Haves

A master's degree in Healthcare Administration, Business Administration, Public Health, or a related discipline is preferred.

Responsibilities

Develop and execute enterprise-wide operational strategies aligned with organizational goals and growth objectives.
Serve as a key member of the executive leadership team, contributing to strategic planning, organizational transformation, and market expansion.
Lead operational readiness for new products, geographic expansion, mergers, acquisitions, and business integrations.
Foster a culture of accountability, collaboration, innovation, and continuous improvement.
Provide executive oversight of: Claims administration and payment operations, Member services and customer experience, Provider services and provider relations, Enrollment, eligibility, and premium billing, Utilization management support operations, Care coordination support services, Appeals and grievances, Credentialing and provider data management, Delegation oversight and vendor management, and Operational compliance and audit readiness.
Ensure compliance with Centers for Medicare & Medicaid Services regulations and Medicare Advantage requirements.
Oversee Medicare Star Ratings operational initiatives and support quality improvement programs that enhance member outcomes and plan performance.
Lead operational support for Risk Adjustment, HEDIS, CAHPS, Medicare Part C and Part D requirements, and annual enrollment activities.
Ensure readiness for CMS audits, program audits, regulatory reporting, accreditation reviews, and regulatory examinations.
Direct operational performance for Medicaid programs in accordance with state-specific Medicaid contracts and federal regulations.
Support initiatives addressing health equity, social determinants of health, and vulnerable populations.
Oversee member outreach, eligibility processes, care management support, and community-based program coordination.
Ensure achievement of contractual performance guarantees and quality measures.
Lead operational functions supporting employer-sponsored, individual, and exchange-based health plan products.
Drive service excellence for members, brokers, employer groups, and providers.
Support product implementation, benefit administration, and operational scalability.
Monitor operational performance to improve retention, growth, and customer satisfaction.
Collaborate with clinical and network leadership to support integrated care delivery models.
Align health plan operations with value-based care strategies and population health initiatives.
Facilitate coordination among providers, hospitals, care management teams, and health plan departments.
Support accountable care arrangements, risk-sharing programs, and integrated operational workflows.
Establish and monitor key performance indicators, operational scorecards, and service-level agreements.
Drive operational excellence through Lean, Six Sigma, automation, process redesign, and other continuous improvement methodologies.
Leverage analytics and technology to improve efficiency, quality, and the member and provider experience.
Identify operational risks and implement appropriate mitigation strategies.
Ensure compliance with CMS regulations, state insurance regulations, NCQA standards, URAC requirements, HIPAA, and other applicable regulatory frameworks.
Partner with compliance, legal, and quality departments to strengthen governance and oversight programs.
Support organizational quality improvement and accreditation initiatives.
Oversee operational budgets and resource allocation.
Drive cost-containment strategies while maintaining service quality and regulatory compliance.
Evaluate vendor performance and negotiate service agreements to maximize value and operational effectiveness.
Support the achievement of medical loss ratio, administrative cost, and profitability targets.
Lead and develop high-performing operational teams across multiple functions and markets.
Establish succession planning and leadership development initiatives.
Promote employee engagement, professional growth, and organizational effectiveness.
Build strong partnerships across clinical, finance, compliance, information technology, and network management teams.
Perform other duties as assigned in support of departmental goals.