Director – MSO Operations

Incuvio Health Inc.; United States; Hybrid; USD 120,000 - 150,000; Full time

Job summary

A healthcare operations firm is seeking a Director for MSO Operations to oversee and scale operational functions in a US-based MSO/IPA environment. Candidates should have at least 12 years of healthcare operations experience, particularly in claims management and compliance. The role includes leading day-to-day operations, ensuring audit readiness, and driving efficiency. Strong communication and management skills are essential for success. The position can be remote or hybrid.

Qualifications

• 12+ years of experience in US MSO, IPA, or delegated healthcare operations.
• Proven experience leading cross-functional operational teams.
• Strong understanding of US healthcare regulations and payer expectations.

Responsibilities

• Lead day-to-day MSO operations across various functions.
• Ensure operational readiness for audits and regulatory reviews.
• Drive operational efficiency and scalability as membership grows.

Skills

Claims operations and adjudication

Capitation and risk-based payment models

Delegated oversight and compliance

Provider network operations

Supporting Medicare Advantage

Leading cross-functional teams

Communication skills

Job description

We are seeking a Director – MSO Operations to lead and scale operational functions across a US-based delegated MSO/IPA environment. This role owns end-to-end operational execution, ensuring regulatory compliance, financial performance, and tight coordination across claims, finance, compliance, and clinical operations.

This role is ideal for someone who has run MSO operations in the US healthcare system, understands payer expectations, and can operate comfortably in environments with delegated risk.

Key Responsibilities:

• Lead day-to-day MSO operations, including claims, eligibility, capitation, UM/CM coordination, and delegated oversight
• Ensure operational readiness for CMS audits, health plan delegated audits, and regulatory reviews
• Partner with internal teams and external payers to ensure accurate and timely execution of operational workflows
• Own KPIs related to claims turnaround time, encounter submission, provider payments, and SLA performance
• Drive operational efficiency, scalability, and process standardization as membership grows
• Serve as the escalation point for payer issues, operational risks, and provider-related challenges
• Support onboarding of new health plans and expansion of delegated services
• Ensure operational activities align with payer contracts, delegation agreements, and regulatory requirements

Required Experience & Skills

• 12+ years of experience in US MSO, IPA, or delegated healthcare operations
• Strong working knowledge of:
• Claims operations and adjudication
• Capitation and risk-based payment models
• Delegated oversight and compliance
• Provider network operations
• Experience supporting Medicare Advantage, Medicaid, and Managed Care plans
• Proven experience leading cross-functional operational teams
• Strong understanding of US healthcare regulations and payer expectations
• Excellent communication and stakeholder management skillsa

Nice to Have

• Experience supporting CMS or health plan audits
• Familiarity with healthcare operations platforms (claims, care management, encounter systems)
• Experience in high-growth or evolving MSO environments

Location: United States (Remote / Hybrid) Employment Type: Full-Time