Chief Operations Officer - Aspire Health Job Listing at Montage Health in Monterey, CA (Job ID A76E6D6411798264492572BCE8B591F4)

Description

Welcome to Montage Health's application process!

Job Description:

The Aspire Health Chief Operating Officer (COO) is a key member of the Aspire Health Executive Team and is responsible for the overall operational strategy, performance, and execution of Aspire's Medicare Advantage, Commercial Risk, and Third-Party Administrator (TPA) lines of business. The COO provides executive leadership across core operational functions, including health plan operations, risk adjustment, network management, delegation oversight, customer experience, and growth-related functions such as sales and marketing.

The COO is accountable for end-to-end operational performance, including oversight of TPA operations and outsourced claims administration, ensuring performance against service level expectations, regulatory requirements, and organizational goals. This includes responsibility for operational outcomes such as claims accuracy and timeliness, enrollment and eligibility processing, vendor performance, and member and provider experience.

In partnership with the Chief Executive Officer and Executive Team, the COO leads the development and execution of Aspire's strategic and tactical plans and ensures alignment across operational, financial, and growth priorities. The COO works closely with Clinical, Quality, Compliance, and Finance leadership to ensure operational excellence, regulatory compliance (including CMS and DMHC requirements), and the delivery of high-quality, cost-effective care and services.

The COO provides leadership and direction to operational and business unit leaders, fosters a high-performing and accountable culture, and ensures the effective integration of internal functions and external partners to meet Aspire's mission and strategic objectives.

Responsibilities

• Executive Operational Leadership

  • Responsible executive for direction and operations of the following departments/functions of company:

    • Enrollment & Eligibility

    • Benefit Configuration, Claims & Payment Integrity

    • Provider/Facility Contracting & Credentialing

    • Network Management

    • Coastal TPA Operations

    • Customer Experience and Service

    • Sales, Marketing, and Business Development

    • Market Analysis and Product Development

    • Commercial Payor Relationships

    • Delegation Oversight and Vendor Management

    • Regulatory Reporting & Interoperability

  • Leads the execution of operational strategy in alignment with organizational goals for Medicare Advantage, Commercial Risk, and TPA lines of business.

  • Directs and develops operational leadership to ensure alignment, accountability, and high performance across all functional areas.

• TPA, Vendor, and Claims Oversight

  • Provides executive oversight of Third-Party Administrator (TPA) operations, including outsourced claims administration and related operational functions.

  • Accountable for performance of outsourced and delegated functions, including claims processing accuracy, timeliness, compliance, and service levels.

  • Oversees vendor contracting and performance management, ensuring adherence to contractual obligations, service level agreements (SLAs), and regulatory requirements.

  • Ensures effective oversight of delegated entities, including monitoring, auditing, and implementation of corrective action plans as needed.

  • Serves as the lead executive for the payment integrity program, ensuring operational efficiency, accuracy, and cost effectiveness.

• Regulatory, Compliance, and Audit Oversight

  • Ensures operational compliance with all applicable federal, state, and regulatory requirements, including CMS and DMHC standards, in coordination with the Compliance Officer.

  • Partners with Compliance and Executive Leadership in managing relationships with regulatory agencies.

  • Serves as executive sponsor for operational readiness and response to state, federal, and partner audits, including oversight of corrective action plans.

  • Oversees required regulatory reporting, including annual reporting and interoperability requirements.

• Strategic Planning and Performance Management

  • Partners with the Chief Executive Officer and Executive Team to develop and execute strategic and tactical business plans.

  • Leads annual business planning processes, including operational strategy, performance targets, and market responsiveness.

  • Reports operational performance, key metrics, and strategic progress to the CEO and Board of Directors on a regular basis.

  • Identifies trends, risks, and opportunities, and recommends and implements corrective actions or strategic initiatives.

• Financial and Operational Performance

  • Develops and manages operational and administrative budgets for areas of responsibility.

  • Monitors financial and operational performance, identifying opportunities for cost optimization and efficiency.

  • Ensures alignment of operational performance with financial goals and organizational objectives.

• Policy, Process, and Integration

  • Oversees the development, review, and implementation of policies and procedures to ensure consistency, compliance, and operational integration across functions.

  • Ensures effective coordination across operational, clinical, financial, and administrative functions.

• Leadership and Organizational Development

  • Leads, coaches, and evaluates direct reports and senior operational leaders.

  • Builds and sustains a high-performing, accountable, and collaborative organizational culture.

  • Promotes an inclusive, participatory, and mission-driven work environment.

• External Partnerships and Business Development

  • Supports the CEO in negotiating and implementing contracts with federal, state, and commercial partners, including plan-to-plan relationships.

  • Leads or supports key initiatives related to growth, partnerships, and market expansion.

• Additional Responsibilities

  • Performs other duties as assigned by the Chief Executive Officer.

Organizational Collaboration

• In addition to the direct oversight outlined above, the COO will be an efficient collaborator across functions that cross departments, including but not limited to Finance, Pharmacy, and Clinical Services.

Experience

• Minimum of ten years of experience in the management of a health plan.

• Strong financial background with particular emphasis on risk management within a capitated environment as acquired through years at the senior managerial level of a Medicaid/Medicare HMO or federally qualified community health center.

• Familiarity with marketing, advertising and promotional activities are beneficial.

Education

• Bachelor's degree required; Master's degree preferred.

• Degree preferred in business administration, health care administration, finance, or a related discipline.

Competencies

• Problem Solving and Decision Making: Identifies, analyzes, organizes, and solves problems and issues in a timely, effective manner; uses data and input from others to make sound, timely decisions even in the face of uncertainty.

• Integrity: Consistently honors commitments and takes responsibility for actions and words. Proficient in use of the financial/accounting software system.

• Flexibility: Demonstrates adaptability and openness to alternative solutions and flexibility when interacting with others, understanding their attitudes, needs, interests, and perspectives.

• Inclusiveness: The ability to network and partner with all internal and external stakeholders including broad and diverse representation of private/public and traditional/non-traditional community organizations.

Equal Opportunity Employer

Assigned Work Hours:

Full time

Position Type: