COO - 247205

Medix™; Chino (CA); On-site; USD 250,000 - 325,000; Full time

Job summary

A healthcare organization is seeking an experienced Chief Operating Officer (COO) to lead operations and compliance. The ideal candidate will have extensive experience in managed care operations and a proven ability to guide organizations towards operational excellence. This role requires strategic leadership and daily operational oversight, focusing on provider networks and regulatory standards.

Qualifications

• 12-15 years of experience in healthcare or managed care operations.
• At least 7 years in a senior leadership role.
• Strong understanding of DMHC licensing and CMS contracting.

Responsibilities

• Oversee daily operations including claims and enrollment.
• Lead operational readiness for DMHC and CMS approvals.
• Build and manage a provider network.

Skills

Operational leadership

Regulatory expertise

Analytical skills

Financial management

Problem-solving

Education

Master’s degree in Healthcare Administration or Business

Job description

This range is provided by Medix™. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$250,000.00/yr - $325,000.00/yr

A healthcare organization is seeking an experienced and hands‑on Chief Operating Officer (COO) to lead operations, compliance, and network development. This role is ideal for a leader with strong operational and regulatory expertise in managed care, including familiarity with DMHC, CMS, and delegated oversight requirements. The COO will play a critical role in guiding the organization from regulatory readiness to sustained operational excellence.

Key Responsibilities

Operational Leadership & Strategy

• Oversee daily operations including claims, member services, enrollment, provider relations, and delegation oversight.
• Lead operational readiness activities for DMHC and CMS approvals, ensuring compliance with all regulatory filings and standards.
• Develop and implement operational policies, procedures, and performance metrics to ensure efficiency and service quality.
• Collaborate with shared service teams such as finance, IT, HR, and compliance to streamline processes and optimize resources.

Network & Market Development

• Build and manage a provider network that meets regulatory adequacy standards and supports value‑based care models.
• Negotiate and manage contracts with hospitals, physician groups, and ancillary providers.
• Foster collaborative relationships with provider groups, IPAs, MSOs, and community partners.

Compliance & Quality Management

• Partner with compliance leadership to ensure operational adherence to DMHC and CMS regulations.
• Lead audit readiness, encounter data accuracy, and oversight of delegated entities.
• Support quality initiatives, including HEDIS, CAHPS, and STARs programs, to enhance plan performance.
• Work with finance leadership to monitor budgets, fiscal soundness (TNE), and vendor performance.
• Identify opportunities to improve administrative efficiency and control costs.

People & Culture

• Build and mentor a collaborative and high‑performing operations team.
• Foster a culture of accountability, transparency, and service excellence.

Qualifications

• Master’s degree in Healthcare Administration, Business, or related field preferred.
• 12–15 years of experience in healthcare or managed care operations, including at least 7 years in a senior leadership role.
• Strong understanding of DMHC licensing, CMS contracting, and delegated oversight models.
• Proven ability to lead organizations through growth, start‑up, or turnaround phases.
• Excellent analytical, financial, and problem‑solving skills.
• Hands‑on leadership style with the ability to balance strategic planning and daily execution.

Seniority level: Executive

Employment type: Full‑time

Job function: Health Care Provider