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:Impresiv Health is seeking an experienced Vice President of Operations on behalf of a leading Medicare Advantage health plan organization. This executive leader will provide strategic and operational oversight across core health plan functions, driving operational excellence, regulatory compliance, organizational growth, and exceptional member experiences. The Vice President of Operations will serve as a key member of the leadership team, responsible for developing and executing enterprise operational strategies while ensuring alignment with organizational goals, regulatory requirements, and performance objectives. This role requires a seasoned healthcare executive with deep expertise in Medicare Advantage, managed care operations, and large-scale operational leadership.
What You Will Do:- Provide executive leadership and oversight for health plan operations, including enrollment, claims administration, provider operations, member services, utilization management support, and delegated vendor performance.
- Develop and execute operational strategies that support organizational growth, scalability, and long-term business objectives.
- Establish and monitor key performance indicators (KPIs), operational dashboards, and service-level metrics to drive accountability and performance improvement.
- Ensure compliance with CMS, NCQA, HIPAA, state regulatory requirements, and all applicable healthcare regulations.
- Lead operational readiness initiatives, audits, accreditation activities, and corrective action plans.
- Collaborate with executive leadership to drive organizational transformation, process optimization, and operational efficiencies.
- Partner with clinical, compliance, finance, provider network, and technology teams to improve cross-functional performance and member outcomes.
- Support initiatives that improve member satisfaction, quality performance, risk adjustment accuracy, and Medicare Star Ratings.
- Oversee vendor management and delegated entities to ensure performance standards and contractual obligations are met.
- Identify opportunities to streamline workflows, reduce administrative burden, and improve operational effectiveness.
- Lead workforce planning, talent development, succession planning, and organizational design initiatives.
- Present operational performance updates, strategic recommendations, and business insights to executive leadership and stakeholders.
- Foster a culture of accountability, innovation, collaboration, and continuous improvement.
You Will Be Successful If:- You have significant leadership experience within Medicare Advantage, managed care, or health plan operations.
- You can effectively balance strategic vision with operational execution.
- You possess a deep understanding of CMS regulations, Medicare Advantage requirements, and healthcare compliance standards.
- You use data and analytics to drive operational decision-making and measurable results.
- You are a collaborative leader who builds strong relationships across departments and stakeholder groups.
- You have successfully led large-scale operational improvement and transformation initiatives.
- You can navigate complex regulatory environments while maintaining operational excellence.
- You are passionate about improving member experiences and healthcare outcomes.
- You are comfortable leading through growth, change, and evolving business priorities.
- You have a track record of building and developing high-performing teams
What You Will Bring:- Bachelor's degree in Healthcare Administration, Business Administration, Public Health, or a related field required.
- Master's degree (MBA, MHA, MPH, or related discipline) preferred.
- 10+ years of progressive leadership experience within managed care, Medicare Advantage, Medicaid, or health plan operations.
- 5+ years of executive-level leadership experience overseeing multiple operational functions.
- Extensive knowledge of Medicare Advantage operations, CMS regulations, Star Ratings, HEDIS, Risk Adjustment, and managed care principles.
- Experience leading health plan operational functions including claims, enrollment, provider services, member services, utilization management, or network operations.
- Demonstrated success leading operational improvement, business transformation, and performance optimization initiatives.
- Strong financial and business acumen, including budget management and operational forecasting.
- Experience supporting regulatory audits, accreditation reviews, and compliance programs.
- Exceptional communication, leadership, presentation, and stakeholder management skills.
- Proven ability to build, mentor, and retain high-performing teams.
- Proficiency with healthcare operations technology platforms, reporting tools, and analytics solutions.
