Director, Operations

This position is intended to start January 2026.

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

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.

POSITION SUMMARY

The Director, Operations, in collaboration with the Chief Operating Officer and colleagues, is responsible for the strategic direction and management of daily operations for Oversight, PDRs, Payment Integrity (PI), Joint Operations Meetings (JOMs), JQRs, Regulatory Reporting, and the management of various outsourced services, including but not limited to, mail room processing and recoveries. The successful candidate will assist in implementing the organization’s strategic goals, by directing the implementation of new programs and systems, developing, and maintaining policies and procedures and ensuring regulatory/contractual compliance.

This position plays a key leadership role, interacting with all levels of Gold Coast Health Plan (GCHP) staff and external stakeholders, including the Ventura County Medi-Cal Managed Care Commission, executive staff, members, providers, network management, legal counsel, State and Federal representatives and representatives of other agencies.

Distinguishing Characteristics: Responsible for overall policy development, program planning, fiscal management, administration, and operation of assigned Plan functions, programs, and activities. The Director of Operations is responsible for accomplishing goals and objectives and for ensuring that the area served is provided with desired and mandated services in an efficient and effective manner.

Amount of Travel Required: 30% 

Work Schedule: Work protracted and irregular hours and evening meetings or work unusual hours for meeting attendance or participation in specific projects or programs. 

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.

ESSENTIAL FUNCTIONS

Job Function & Responsibilities

•    Responsible for strategic direction and daily management of key operations areas - Vendor Management, Encounter Processing, Recoveries, Payment integrity, and ensures the development and management of performance measurement, management controls, critical success factors and key performance indicators.

•    Vendor Management is a key responsibility of this position. The candidate will be expected to become familiar with all aspects of the outsourcing contracts and manage the GCHP vendor partners ensuring that all operational functions are managed in accordance with contract terms, regulatory requirements, and industry standards.

•    Establish and ensure adherence to Medi-Cal, Medicare, DSNP and GCHP policies and procedures for all functional areas of responsibility.

•    Work with the Executive Leader to develop plans for systems and staffing to meet current and future programs, requirements, and initiatives.

•    Reviews plans and budgets of assigned departments monthly and as part of the annual planning process.

•    Facilitate data-driven decision making across operational areas that leads to meaningful actions.

•    Implement new initiatives and resolve problems that cross multiple departments by form