Chief Operating Officer

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 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.

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

•    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