VP of Operations

Location: This is a fully onsite position based in Huntington Beach California. Candidates must be available to work in the office five days per week.

Description:
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.

This position reports to the Chief Operating Officer.

What You Will Do:

• 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 operationsMember services and customer experienceProvider services and provider relationsEnrollment eligibility and premium billingUtilization management support operationsCare coordination support servicesAppeals and grievancesCredentialing and provider data managementDelegation oversight and vendor management andOperational 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.

You Will Be Successful If:

• Operational performance targets and service-level agreements are consistently achieved.
• Medicare Star Ratings and other quality performance measures improve.
• Regulatory compliance requirements are met and audits produce favorable outcomes.
• Member provider and employer satisfaction results meet or exceed established goals.
• Claims accuracy timeliness and operational efficiency improve.
• Financial performance cost-management and budget targets are achieved.
• Employee engagement retention succession planning and leadership development outcomes improve.
• Strategic initiatives and business-growth objectives are implemented successfully.

What You Will Bring:

• A bachelors degree in Healthcare Administration Business Administration Public Health or a related field.
• A masters degree in Healthcare Administration Business Administration Public Health or a related discipline is preferred.
• 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.

About Impresiv Health:

Impresiv Health is a healthcare consulting partner specializing in clinical & operations management enterprise project management professional services and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.

Our approach is and has always been simple. First think and act like the customers who need us and most importantly deliver what larger organizations cannot do provide tangible results that add immediate value at a rate that cannot be beaten. Your success matters and we know it.

Thats Impresiv!