Head of Clinical OperationsCOO

Mae is looking for a Head of Clinical Operations/COO who is passionate about maternal health equity. This is a leadership role responsible for the quality and performance of health plan operations with both team management and team oversight responsibilities. While the primary focus is on Maes health plan related operations this role will also drive cross-functional process improvements and strategic operational initiatives to drive overall business performance. 

The Head of Clinical Operations/COO will report directly to the Chief Executive Officer and directly manage the Claims & Billing Team and the Members Services Team Manager who manages Maes member-facing teams. 

A successful Head of Clinical Operations/COO at Mae is:

• A seasoned clinical operations leader who has historically performed and/or directly overseen day-to-day health plan operations (member-facing care billing & claims management new member enrollment)
• A builder who has rolled up their sleeves to create processes teams and structure driven by strategic priorities
• A people leader who can develop high-potential team members while also mentoring less experienced team members in a fast-paced setting
• Driven by mission and impact motivated by solving complex problems and energized by creating structure and clarity where none existed before
• Technically fluent and system-minded comfortable using and optimizing modern tools and platforms as well as able to design fit-for-purpose workflows within these tools that scale with the organization
• Experienced in and energized by guiding teams through change with clarity and empathy and fostering a culture that embraces continuous improvement

Key responsibilities: 

In your first 90 days: This role requires a blend of tactical and strategic execution. Your first objective is to drive the strategic restructuring of member-facing roles into a new Member Services Team consisting of:

• Outreach Specialists responsible for outbound outreach to health plan members to provide education on Mae and achieve monthly enrollment targets
• Care Coordinators responsible for coordinating more complex member needs providing pregnancy education and conducting health assessments. 
• Member Engagement Specialists responsible for managing routine member communications (phone e-mail text) to encourage doula and platform engagement or facilitating benefits requests.

Alongside a new Member Services Manager you will implement role & process definition to drive our most critical company metrics: new member enrollment and doula utilization. 

You will also take over management of the Claims & Billing Team where you will:

• Manage a team of billing specialists who are responsible for processing Maes health plan claims and doula payments
• Ensure quality and performance standards are defined for core processes and meet the needs of the business
• Review high level billing trends including denials and underpayments

After 90 days: Youll continue to improve and refine your teams processes and performance while transitioning to an oversight role for the Member Services Team. 

• In addition to direct oversight the Head of Clinical Operations/COO will act as a process and quality consultant for the Member Services Team Manager to:
  • Ensure quality and performance standards are defined for mission-critical processes and meet the needs of the business 
  • Ensure internal tools and workflows are optimized for scale
  • Monitor high-level trends and proactively identify opportunities for improvement
  • Collaborate with product engineering and leadership teams to implement designed changes to workflows tools and standards

You will be responsible for executive reporting and strategic planning on key member-facing processes including but not limited to:

• Member support performance & trends (e.g. first-response and resolution objectives)
• Member grievance management (e.g. timeliness to resolution repeated grievances adherence to procedures)
• Claims trends to identify strategic opportunities to improve processing to minimize risks
• Improper billing investigation trends collaborating with Compliance to develop enhanced fraud waste and abuse prevention tactics 

With our cross-functional leadership team youll develop a strategic operational roadmap aligned to our company goals with a focus on:

• Internal Tool Ownership & Optimization: Maintain a detailed understanding of internal tools critical to health plan operational processes (e.g. third-party billing platform customer support ticketing platforms internal VOIP/phone system). This understanding will drive strategic insights such as:
  • Optimized workflows efficiency and collaboration
  • Identifying when the tool is no longer fit-for-purpose and source new and improved solutions

• Quality Change Management & Process Improvement Initiatives:

  • Evaluate the comprehensiveness & quality of procedural documentation and develop strategies to improve and align to a cohesive internal standard
  • Define and implement strategic change management initiatives to improve quality performance and efficiency
  • Drive process optimization initiatives using data-driven methodologies such as Lean Six Sigma or similar frameworks
  • Collaborate with cross-functional teams to implement process improvements and ensure alignment across departments
  • Report on operational performance and present findings and recommendations to leadership for strategic decision-making
  • Maintain oversight of member engagement and billing related product enhancements

Qualifications :

What we are looking for:

• Bachelors Degree
• 5 years combined experience in health plan operations with demonstrated process improvement/change management responsibilities
• Experience working in fast-paced or start-up environments
• People management experience
• Strong understanding of quality management systems and performance measurement frameworks (e.g. KPIs SLAs)
• Demonstrated experience developing and managing standard operating procedures and documentation
• Exceptionally organized and process oriented
• Thoughtful strategic and efficient
• Strong proactive and responsive verbal and written communicator

Preferred Experience:

• Masters Degree (e.g. MBA) or Process Methodology Certifications (e.g. Lean Six Sigma)

Additional Information :

Benefits include

• Competitive salary and equity
• Healthcare benefits
• 401K
• Flexible work location

Additional Information

• Salary range: $140000 - $175000 annually depending on experience
• 40 hours/week expected (standard business hours Monday - Friday)

We are currently only hiring US based applicants and are unable to sponsor visas. All your information will be kept confidential according to EEO guidelines.

All your information will be kept confidential according to EEO guidelines.

Mae Health Participates in E-Verify

This employer participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. If E-Verify cannot confirm that you are authorized to work this employer is required to give you written instructions and an opportunity to contact Department of Homeland Security (DHS) or Social Security Administration (SSA) so you can begin to resolve the issue before the employer can take any action against you including terminating your employment. Employers can only use E-Verify once you have accepted a job offer and completed the Form I-9.

Remote Work :

No

Employment Type :

Full-time