Chief Operating Officer - #260889

Chief Operating Officer

Camarillo, CA - Hybrid

POSITION SUMMARY

The Chief Operating Officer (COO) is a member of the executive management team and reports directly to the Chief Executive Officer (CEO). The COO is responsible for the overall operational performance of the enterprise, and to ensure a well-run, operational capable organization. The COO provides leadership and oversight of core health plan operations, such as Claims Management, Member Grievance and Appeals, Provider Operations and Services, Member and Provider Contact Center Services, and Provider Contract Management. Additional areas include Operational Assurance and Enterprise Data, Analytics and Insights. This position has overall responsibility for policy development, program planning, fiscal management, administration and operation of assigned Plan functions, programs and activities. The position assists the CEO and executive team in developing and implementing the organization’s strategic plan and related goals.

Amount of Travel Required: 10% as needed

Work Schedule: Hybrid Work and protracted and irregular hours and evening meetings or work irregular hours for attendance at meetings for special projects and programs.

ESSENTIAL FUNCTIONS

Job Function & Responsibilities:

• Lead strategic planning and program development for the Operations organization.

• Lead and ensure effective operations of core operations functions. Internal staff and departments are provided with direction and support to fulfill their functions. Lead the operations to achieve the targeted key performance indicators.

• Establish and maintain appropriate procedures and controls to ensure accuracy. Analyze and recommend changes in organizational systems, policies and procedures improve organization performance and achieve regulatory compliance. Establish policies and guidelines for operational excellence and regulatory compliance. Be fully compliant with regulatory requirements. Policies, procedures and guidelines are created and regularly reviewed for operational excellence

• Primary areas of responsibility include Claims Management, Member Grievance and Appeals, Provider Operations and Services, Member and Provider Contact Center Services, and Provider Contract Management and Enterprise Data, Analytics and Insights.

• Accountable for all outsourced services and related third-party vendor relations to ensure targeted outcomes are delivered and achieved.

• Manages budgets of assigned departments and ensure compliance of each area with current state and federal laws and regulations.

• Initiate, implement and review activities to advance quality, improve member, provider and employee satisfaction, reduce expenses and increase staff productivity.

• Responsible for reporting and analysis in achievement of department goals.

• Collaborate with internal and external customers and stakeholders to resolve issues and enhance relationships. Ensures the organization and its mission, programs, products, and services are consistently presented in a strong, positive image to relevant stakeholders.

• The position assists the CEO in implementing the organization’s strategic goals.

MINIMUM QUALIFICATIONS

Education & Experience:

• Bachelor's Degree (four-year college) Required, Field of Study: in an appropriate discipline.

• 8+ years of progressively responsible experience in managed healthcare leadership, with previous executive leadership experience reporting to a CEO level of a similar type of organization

• 8+ years of experienced management expertise

• Proven success with challenging work in a complex organizational structure

• Managing a P&L and delivering results is critical

• Experience with outside regulators, governmental entities, etc.

• Must have strong business and managed care acumen and a demonstrable record of achieving net results throughout their career.

• Must be a proven strategic thinker and good planner will be essential, along with someone who can communicate well and motivate others.

• Proven execution against aggressive objectives.

• Strong organizational leadership, administration, analytical, negotiation and financial management skills.

• Excellent communication - written, verbal and interpersonal skills.

• Proven ability to develop and maintain strong business relationships.

• Experienced policy development, program planning, fiscal management, administration and operation of assigned Plan functions, programs and activities.

KNOWLEDGE, SKILLS & ABILITIES

Preferred Qualifications:

• Master's Degree Preferred, Field of Study: Business, Healthcare or Public Administration is preferred.

• Experience working within a matrix management structure is preferred.

• Knowledge of Medi-Cal and Medicare is preferred.

Technology & Software Skills:

• Advanced computer skills in MS Office products.

Certifications & Licenses:

• A valid and current Driver's License, Auto Insurance, and professional licensure(s)

Competency Statements

• Management Skills - Ability to organize and direct oneself and effectively supervise others.

• Business Acumen - Ability to grasp and understand business concepts and issues.

• Decision Making - Ability to make critical decisions while following company procedures.

• Goal Oriented - Ability to focus on a goal and obtain a pre-determined result.

• Cultural Alignment – Ability to think and act within a Community-based, Mission-driven culture focused on connecting Member with quality care.

• Interpersonal - Ability to get along well with a variety of personalities and individuals.

• Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.

• Time Management - Ability to utilize the available time to organize and complete work within given deadlines.

• Consensus Building - Ability to bring about group solidarity to achieve a goal.

• Relationship Building - Ability to effectively build relationships with customers and co-workers.

• Presentation Skills - Ability to effectively present information publicly.

• Delegating Responsibility - Ability to allocate authority and/or task responsibility to appropriate people.

• Leadership - Ability to influence others to perform their jobs effectively and to be responsible for making decisions.

• Strategic Planning - Ability to develop a vision for the future and create a culture in which the long-range goals can be achieved.

• Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards.

• Judgment - The ability to formulate a sound decision using the available information.

• Communication, Oral - Ability to communicate effectively with others using the spoken word.

• Communication, Written - Ability to communicate in writing clearly and concisely.

• Problem Solving - Ability to find a solution for or to deal proactively with work-related problems.

Salary Range:$258,750.00 To $431,250.00 Annually

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in.

Work Culture:

GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive. This philosophy enables us to create the health plan of the future and do our best work – Together.

GCHP promotes a flexible work environment. Employees may work from a home location or in the GCHP office for all or part of their regular workweek (see disclaimer).

GCHP’s focuses on 5 Core Values in the workplace:

• Integrity

• Accountability

• Collaboration

• Trust

• Respect

Reasonable Accommodations Statement: To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

Disclaimers:

• Flexible work schedule is based on job duties, department, organization, or business need.

• Gold Coast Health Plan will not sponsor applicants for work visas.