The Director, Process Improvement & Operational Excellence is responsible for identifying, prioritizing, and leading cross-functional initiatives that improve operational performance, scalability, quality, and efficiency across the organization.

This role partners with business leaders to evaluate current operating models, identify opportunities for improvement, redesign processes, and implement sustainable solutions that improve business outcomes. The Director leads improvement initiatives that simplify workflows, reduce operational friction, enhance service delivery, and strengthen organizational performance.

Working across multiple functions within a Medicare Advantage environment, this leader serves as an internal transformation partner, helping business areas solve complex operational challenges through process redesign, performance management, and disciplined execution.

Job Responsibilities:
Operational Excellence & Process Improvement

• Identify operational inefficiencies, performance gaps, and workflow bottlenecks across the organization.
• Lead current-state and future-state process redesign efforts that improve efficiency, quality, scalability, and service performance.
• Implement process improvements that reduce complexity, improve operational outcomes, and enhance member and provider experiences.
• Establish standards, best practices, and continuous improvement methodologies across supported business areas.

Business Transformation & Strategic Initiatives

• Lead cross-functional initiatives that support strategic business objectives and operational transformation efforts.
• Partner with business leaders to evaluate operating models and identify opportunities for increased effectiveness and scalability.
• Develop implementation plans and drive execution of approved transformation initiatives.
• Support organizational adoption of new processes and operating models.
• Ensure initiatives are successfully implemented and achieve defined business outcomes.

Performance Management & Operational Insights

• Establish performance measures and success metrics for operational improvement initiatives.
• Analyze operational performance data and identify opportunities for improvement.
• Develop reporting and dashboards that provide visibility into initiative progress and business outcomes.
• Quantify operational, financial, and service impacts resulting from transformation efforts.

Leadership & Stakeholder Partnership

• Build and lead a team responsible for process improvement and transformation initiatives.
• Influence stakeholders across business functions and build alignment around improvement priorities.
• Serve as an advisor to leadership regarding operational performance, scalability, and continuous improvement opportunities.

Supervisory Responsibilities:

• Build and lead a high-performing team responsible for program management, process improvement, business analysis, and transformation delivery.
• Mentor and develop direct reports.
• Foster a collaborative, accountable, and results-oriented culture.

Job Requirements:

Experience:
Required:

• Minimum 7 years of progressive leadership experience in provider operations, network management, healthcare operations, provider engagement, business transformation, operational excellence, or related functions.
• Minimum 5 years leading large-scale cross-functional transformation initiatives in a healthcare, managed care, provider, MSO, IPA, or health plan environment.
• Experience developing business cases, transformation roadmaps, performance measurement frameworks, and executive-level presentations.
• Experience implementing Lean, Six Sigma, Agile, or other continuous improvement methodologies.
• Strong experience developing KPIs, operational dashboards, and performance management systems.
• Demonstrated working knowledge of healthcare delivery models, provider performance management, referral management, care routing frameworks, and value-based care principles

Preferred:

• Medicare Advantage experience with a strong understanding of provider operations, network management, provider engagement, Stars performance, and value-based care.
• Experience implementing technology platforms, digital tools, AI-enabled solutions, or workflow automation capabilities.
• Experience supporting delegated, risk-bearing, IPA, ACO, MSO, or integrated delivery system models.

Education:

Required:

• Bachelor's degree in Healthcare Administration, Business Administration, or a related field; four years of additional directly relevant experience may be considered in lieu of a degree

Preferred:

• MBA, MHA, or equivalent graduate degree with concentration in healthcare operations, strategy, or technology

Training:

Preferred:

• Formal training in Lean, Six Sigma, Agile, Project Management, Human-Centered Design, or Organizational Change Management.
• Certification in process improvement, project management, or business transformation methodologies.
• Formal training in product management, digital transformation, change management, or healthcare operations leadership

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $149,882.00 - $224,823.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.