VP, Operations

Job not on LinkedIn

🔥 2 minutes ago

🇺🇸 United States – Remote

💵 $170k - $190k / year

⏰ Full Time

🔴 Lead

⚙️ Operations

👻 Ghost score 0%

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Reliant Health Partners

WebsiteLinkedInAll Job Openings

11 - 50 employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 B2B

Healthcare • Healthcare Insurance • B2B

Reliant Health Partners is a data-driven healthcare cost-containment firm that provides medical-claims repricing and Fair Market Pricing solutions for self-funded health plans. Working with TPAs, brokers, and bill-review organizations, Reliant delivers open-access plan replacement, out-of-network and casualty repricing, end-to-end appeals management, and rapid claim turnaround using proprietary analytics to maximize savings while minimizing provider dispute and administrative noise.

📋 Description

• Lead and transform a multifunction healthcare cost-containment organization overseeing approximately 25 employees • Manage teams negotiating No Surprises Act disputes before Independent Dispute Resolution (IDR) • Own end-to-end IDR operational performance, including intake, case matching, filing milestones, decisions, repricing, client notifications, exceptions, and audit trails • Lead negotiation and resolution of appeals related to out-of-network repricing products • Oversee Provider Data Management, including data quality, throughput, capacity, and automation opportunities • Lead Client Services with clear service levels, issue ownership, and escalation • Oversee the dedicated Medicaid claims repricing operation supporting the Kaiser account • Own operating results across quality, timeliness, productivity, service, compliance, capacity, and cost • Implement dashboards and operating-management systems covering backlog, throughput, staffing productivity, exceptions, deadlines, and trends • Design and document process maps, handoffs, ownership, escalation pathways, reconciliations, and completion evidence • Build NSA/IDR controls for communications, critical dates, claim-to-dispute matching, client communication, financial exposure, and auditability • Lead cross-functional redesign with IT, product, finance, legal/compliance, and account management • Translate business requirements into prioritized technology roadmaps • Deploy AI, document intelligence, and workflow automation with human review, privacy, and control safeguards • Develop staffing and capacity models, resource plans, budgets, succession coverage, and organizational structure • Coach managers and establish weekly performance reviews, risk escalation, and continuous improvement • Communicate risks and recommendations to executive leadership • Support enterprise integration, standardization, growth, and acquisition readiness • Establish operational baselines, validate IDR controls, produce workflow documentation, implement operating reviews, and present a sustainable staffing and leadership structure within the first 90–180 days

🎯 Requirements

• 15+ years of progressive healthcare operations experience, including substantial senior leadership responsibility for complex, multi-team operations • Demonstrated hands-on expertise in the federal No Surprises Act, open negotiation, federal IDR processes, out-of-network claims and repricing, and associated operational deadlines and communications • Proven record of building KPI-driven management systems, redesigning workflows, improving service and quality, and scaling operations • Experience leading managers and cross-functional teams through operational change, technology implementation, and high-stakes issue resolution • Strong quantitative and financial acumen, including workload forecasting, staffing models, productivity, and cost management • Excellent executive communication, judgment, prioritization, decision-making, and risk-management skills • Experience with health plans, third-party administrators, cost-containment vendors, claims administrators, or related payer services (preferred) • Demonstrated implementation of AI-assisted document processing, intelligent intake, workflow orchestration, and automated operational reporting (preferred) • Experience with Medicaid repricing, provider data operations, appeals negotiations, or post-acquisition integration (preferred) • Bachelor’s degree or equivalent experience; advanced degree desirable

🏖️ Benefits

• Comprehensive medical, dental, vision, and life insurance coverage • 401(k) retirement plan with employer match • Health Savings Account (HSA) & Flexible Spending Accounts (FSAs) • Paid time off (PTO) and disability leave • Employee Assistance Program (EAP)