Chief Operations Officer

Signature Advantage

The Chief Operations Officer (COO) is a pivotal member of the Signature Advantage Medicare Advantage (MA) health plan's Executive Leadership team. This role is responsible for the overall operational performance and execution of the organization's strategic vision across its SNF and ALF aligned model of care. The COO will aid in driving excellence in care delivery, provider engagement, regulatory compliance, and system optimization, ensuring that the organization remains scalable, efficient, and well-positioned within the rapidly evolving healthcare landscape. The ideal candidate brings in-depth health plan operations experience and knowledge with demonstrated leadership in post-acute settings, including Skilled Nursing Facilities (SNFs) and Assisted Living Facilities (ALFs).

Operational Leadership

Design, develop, refine and lead operational strategies, systems, and workflows across health plan domains to improve quality, outcomes, and efficiency.
• Deep understanding of all operational aspects of the Medicare Advantage Special Needs Plan including enrollment, claims administration, provider contracting, care management, utilization review, compliance, and reporting.
• Establish internal processes that ensure accurate, timely, and compliant execution of core plan functions in line with CMS Part C & D regulations
• Manage relationships with technology and services partners.
• Oversee operational partners to ensure accuracy, timeliness and compliance.
• Monitor key operational metrics and implement performance improvement initiatives to drive operational excellence and member satisfaction.
• Direct and oversee the Pharmacy Benefit Manager (PBM) and Third-Party Administrator (TPA)

Regulatory and Compliance Oversight

• Ensure compliance with CMS Medicare Advantage regulations, including those related to risk adjustment, STARS quality ratings, encounter data submission, and audit readiness.
• Monitor changes in federal and state policy affecting MA plans, post acute care, and long term care, ensuring timely implementation of required changes.
• Experience with CMS application and bid processes, including submission, network adequacy, and regulatory timelines.

Quality, Performance & Outcomes

• Define and track key performance indicators (KPIs) related to clinical quality, financial performance, facility engagement, member satisfaction, member turnover and regulatory standards.
• Lead initiatives to improve member outcomes and reduce avoidable hospitalizations through post acute care innovation and value based care models.
• Identify plan service needs and recommend potential solutions

Strategic Growth & Market Expansion

• Drive market penetration strategies through partnerships with SNFs, ALFs, state associations, and other strategic collaborators.
• Support geographic expansion into new service areas by identifying, contracting, and operationalizing new facility chains and networks.
• Serve as a trusted relationship-builder with facility operators, long-term care associations, and external stakeholders to elevate the plan's reputation and presence.

Organizational Strategy & Transformation

• Partner with the CEO and executive team to execute multiyear growth initiatives and transformation plans.
• Provide operational leadership including change management, compliance, and stakeholder engagement.
• Collaborate cross functionally with product development, actuarial, and finance teams to align operations with annual bid development and benefit design processes.

• Bachelor's degree in Healthcare Administration, Business, Public Health, or a related field required; Master's degree Health Administration, or a related discipline strongly preferred
• 10+ years of progressively responsible leadership in healthcare operations, with at least 5 years in a senior executive role within a Medicare Advantage or related managed care environment.
• Experience working with an Institutional or Institutional Equivalent Special Needs Plan
• Proven experience managing the full spectrum of health plan functions, including claims, enrollment, provider relations, utilization management, appeals and grievances, and CMS compliance.
• Deep familiarity with the operational nuances of small to mid sized plans, with a track record of building scalable processes in a resource conscious environment.
• Experience with Health Plan exchange standards (HL7, X12, FHIR)
• Proven experience overseeing large scale operational systems, compliance programs, and provider networks.
• Experience with CAQH, NCQA, URAC
• In-depth knowledge of post-acute care systems, specifically SNFs and ALFs, including regulatory, clinical, and operational dynamics.
• Deep understanding of CMS regulations, STARS quality measures, risk adjustment methodologies, and value based reimbursement.
• Expertise in leading cross functional teams and implementing organizational change in complex healthcare settings.
• Excellent interpersonal, negotiation, and executive communication skills.
• Strong data driven decision making and project management capabilities.
• Experience working with Third Party Administrators (TPAs), Pharmacy Benefit Managers (PBMs) and navigating delegated or shared risk arrangements.
• Familiarity with long term care payment models, institutional and institutional equivalent special needs plans populations.
• Knowledge of health plan data domains and their relationships (member, provider, claims, network, etc..)
• Travel 25%-75%