Source Job

• Drive day-to-day operational execution of Medicare Advantage and ACA Risk Adjustment initiatives, ensuring milestones and deadlines are met.
• Develop and maintain integrated project plans, operational calendars, and risk logs to support program execution.
• Monitor program performance through dashboards, KPIs, and operational metrics, and recommend data-driven improvements.

Capital Blue Cross is a health insurance company and an independent licensee of the Blue Cross Blue Shield Association. They are consistently voted one of the 'Best Places to Work in PA' and foster a flexible environment with a focus on employee wellbeing.

• Launch Chamber’s ACO and own its performance, proving a specialty-focused model in cardiology.
• Establish and manage ACO governance, compliance, and CMS submission cycles.
• Partner with Finance and Network teams to design payment operations and improve network performance.

Chamber rebuilds the system for cardiology, partnering with independent cardiologists to improve outcomes through technology, data, and operational tools. The company fosters a culture of low ego, empathy, courage, ownership, and grit.

• Lead managers and supervisors responsible for member enrollment and billing operations.
• Drive achievement of client SLAs, quality metrics, productivity, and financial targets.
• Partner with clients and internal stakeholders to identify operational improvements and foster a culture of accountability.

Sutherland leverages artificial intelligence, automation, and cloud engineering to drive digital transformation for iconic brands. With over 200 patents and a focus on human-machine collaboration, the company delivers measurable results through a seamless 'as a service' model.

• Own end-to-end operating model and outcomes for provider engagement and growth programs, ensuring timelines, milestones, and intended results are met.
• Track program performance through data, translate into concise reports for senior leadership, and provide recommendations for prioritization.
• Collaborate with cross-functional teams and engage directly with providers and practice staff to maintain momentum and drive program success.

Counterpart Health transforms healthcare with an AI-enabled primary care tool, Counterpart Assistant, that supports earlier diagnosis and management of chronic conditions. As a subsidiary of Clover Health, they have a remote-first culture with a focus on diversity and inclusion, and thousands of practitioners using their tool.

• Lead high-priority commercial initiatives and drive cross-functional execution across teams.
• Manage strategic partnerships and deliver business insights to inform commercial decisions.
• Serve as a trusted operator to strengthen program execution and operational effectiveness.

Counterpart Health develops an AI-powered primary care tool, Counterpart Assistant, to improve patient outcomes and support physicians in value-based care. They are a remote-first subsidiary of Clover Health with a collaborative and innovative culture.

• Manage implementations for small and mid-market health plan groups as the primary operational contact during onboarding.
• Maintain project plans, timelines, and deliverables; coordinate execution across internal and external teams.
• Coordinate technical and operational launch requirements including eligibility validation, marketing readiness, and client configuration.

Virta Health is on a mission to reverse metabolic disease in one billion people through technology, personalized nutrition, and virtual care. They have raised over $350 million from top-tier investors and partner with major health plans, employers, and government organizations.

• Support the Engagement Center Operations team with day-to-day operations, new site implementations, and strategic initiatives.
• Organize and maintain documentation such as workflows, action plans, and KPI reports to enable operational success.
• Assist with performance metric tracking, audit processes, and troubleshooting growth opportunities.

Shields Health Solutions partners with health systems to improve patient care through specialty pharmacy services. The company fosters a collaborative, data-driven culture with a close-knit team.

• Provide direct operational oversight and support of teams, ensuring performance and service standards are met.
• Lead scheduling, staffing, and queue management to maintain 24/7 coverage while leveraging data analytics for KPI monitoring.
• Collaborate with clinical leadership to optimize workflows, implement innovations, and support value-based care goals.

Privia Health is a technology-driven physician enablement company collaborating with medical groups, health plans, and health systems to optimize practices and improve patient care. It is led by top industry talent and physician leadership, focusing on scalable operations and cloud-based technology.

• Coordinate EHR Go-Live, recovery, and post go-live operations, directing production and distribution of healthcare support services.
• Support value stream enablement and centralized upskilling, including training logistics and resource sequencing for surge tasks.
• Maintain SOPs, trackers, and execution cadences, and contribute to weekly, bi-monthly, and monthly performance reports.

A federal health IT contractor supporting the VHA Office of Clinical Informatics in deploying and stabilizing the Oracle Health Federal EHR. The team focuses on operational execution and coordination across training and value stream work, but company size and culture are not specified in the posting.

• Own operational execution for a partner portfolio, including configuration, billing, integrations, and reporting.
• Lead implementations and escalations, coordinating with internal teams to resolve issues and keep commitments on track.
• Serve as the day-to-day operational point of contact for partners and deliver account business reviews.

Sword Health shifts healthcare from human-first to AI-first through its AI Care platform, reducing costs for payers and employers. Backed by leading investors like Khosla Ventures, the company has raised over $500 million and serves more than 1,000 enterprise clients with over 700,000 members.

• Execute and scale AI-enabled cardiovascular care programs, managing workflows and cross-functional coordination.
• Translate clinical protocols into operational workflows, building SOPs and training materials.
• Integrate AI tools into care workflows and track program performance.

Chamber Cardio rebuilds the cardiology system to improve outcomes through technology, data, and operational tools. They partner with independent cardiologists and blend clinical expertise with AI, operating as a small, innovative team focused on empathy and scale.

• Lead value analysis initiatives to improve healthcare operations and cost-effectiveness.
• Analyze contracts, costs, and product specifications to drive standardization and savings.
• Manage cross-functional projects and facilitate value analysis committees.

A healthcare operations partner focused on value analysis and supply chain optimization. They offer a fully remote work environment and a comprehensive benefits package.

• Lead strategic initiatives to improve STARS, CAHPS, PWP, and HEDIS performance across the health plan.
• Manage a team of 3-6 direct reports and collaborate with cross-functional teams.
• Design and evaluate outreach programs to enhance member experience and close care gaps.

Sentara Health Plans provides health plan coverage to close to one million members in Virginia. It is part of Sentara Health, a not-for-profit integrated healthcare provider with nearly 30,000 employees and a family-friendly culture.

• Drive operational excellence across provider risk adjustment, HCC coding, and value-based care programs while overseeing coding services delivered by domestic and global teams.
• Serve as the primary strategic lead and escalation point for health plan and provider clients, maintaining accountability for service quality and client satisfaction.
• Manage, mentor, and develop diverse coding teams across locations, ensuring coding activities follow organizational standards and regulatory requirements.

Our partner is a company that drives operational excellence in healthcare through risk adjustment, HCC coding, and value-based care programs. They are a senior leadership focused organization that manages coding services with diverse teams, emphasizing quality and compliance.

• Provides oversight of CDI teams, ensuring optimal performance and adherence to compliant CDI practices and regulatory requirements.
• Develops strategic plans to achieve enterprise KPIs and analyzes data to generate monthly performance reports for executive leadership.
• Acts as a liaison between physicians, coding, and clinical quality to ensure accuracy and integrity of the inpatient medical record.

CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, it has more than 157,000 employees and delivers over 20 million patient encounters annually.

• Lead day-to-day and long-term clinical operations across markets and care modalities to achieve access, quality, and financial goals.
• Build and standardize the clinical operating system, including scheduling, staffing, and workflows for scalable multi-site operations.
• Drive cross-functional execution and establish accountability through KPIs, dashboards, and performance reviews.

Tia is building a new model of healthcare for women that integrates primary care, gynecology, mental health, dermatology, and wellness. As a Series D venture-backed company trusted by over 120,000 women, Tia fosters a culture of excellence through continuous improvement, learning, and collaboration.

• Directs and governs the entire self-pay vendor ecosystem, including coverage discovery and bad debt collections.
• Develops vendor strategy, SLAs, KPIs, and leads quarterly business reviews with key vendors.
• Builds and mentors a high-performing team of analysts, ensuring workflow excellence and compliance.

Ventra is a leading business solutions provider for facility-based physicians in anesthesia, emergency medicine, hospital medicine, pathology, and radiology. Focused on Revenue Cycle Management, they partner with private practices and health systems to deliver data-driven solutions, and as a large enterprise with a robust rewards program, they emphasize a collaborative culture.

• Lead end-to-end operating models and drive provider engagement and growth programs in a healthcare tech environment.
• Monitor program performance using data insights, identify risks, and ensure alignment with strategic goals.
• Partner with cross-functional teams and external healthcare providers to create scalable processes and improve outcomes.

Jobgether is an AI-powered job matching platform that connects candidates with opportunities. They use technology to streamline hiring, and this role is listed on behalf of a partner company.

• Lead the strategy to secure national payor agreements, moving from state-by-state enrollment to national in-network contracts with major commercial payors.
• Manage a Credentialing Specialist, setting SLAs and KPIs for credentialing turnaround time, while overseeing payor enrollment and claim denial resolution.
• Partner with Clinical Ops and Revenue Cycle to align provider onboarding with credentialing lead times and national agreement rollouts.

Happy Health is revolutionizing sleep medicine delivery through a comprehensive telehealth platform that eliminates traditional barriers to sleep care. The company is a fast-moving, low-ego team that values ownership and problem-solving over process, operating remotely with a physical office in Austin, TX.

• Manage provider and coach assignments to ensure accurate care team operations.
• Maintain operational data quality and perform analysis to identify inefficiencies.
• Collaborate with cross-functional teams to optimize workflows and support scalable care models.

The company is an innovative healthcare organization that leverages technology to improve clinical operations and patient outcomes. It fosters a collaborative, remote-first culture with a global team.