Vice President of Operations

Organization Overview

Santa Clara Family Health Plan (SCFHP) is a community-oriented health plan committed to enhancing the health and wellness of Santa Clara County residents. Collaborating with healthcare providers and local organizations, SCFHP offers Medi-Cal and SCFHP DualConnect (HMO D-SNP) plans to serve the community.

Position Summary

The Vice President of Operations is a senior executive role responsible for overseeing and aligning the core health plan operations—including enrollment and eligibility, customer service, grievances and appeals, and vendor management—with strategic goals and regulatory requirements. This leader ensures excellence in operational performance, compliance, technology integration, and fosters a culture focused on ongoing improvement and member experience. The role involves significant external representation with partners and regulatory bodies.

Key Responsibilities

• Provide strategic leadership and ultimate accountability for Enrollment and Eligibility, Customer Service, Grievances and Appeals, and Vendor Management operations, ensuring adherence to performance and compliance standards.
• Direct the Directors overseeing Operations and Customer Service to guarantee compliant and efficient processes, including regulatory reporting and root cause analysis.
• Oversee vendor management strategies, contract standards, and performance metrics in collaboration with compliance and legal teams.
• Develop and monitor departmental budgets and individual goals, ensuring resource allocation aligns with organizational objectives.
• Lead cross-functional initiatives with clear goals, deliverables, and performance indicators.
• Maintain thorough knowledge of applicable federal and state healthcare regulations and integrate requirements into policies and procedures.
• Represent SCFHP in regulatory and audit processes, ensuring timely resolution of compliance issues.
• Promote continuous improvement efforts by identifying and driving workflow optimizations for increased efficiency and quality.
• Oversee technology implementation projects, including evaluation and maintenance of performance tracking systems to support data-driven decision-making.
• Prioritize member experience by analyzing data trends to address systemic service gaps and uphold organizational values of accessibility and equity.
• Serve as an external liaison with providers, delegates, community members, and regulators to enhance understanding of health plan services.

Candidate Profile

• Bachelor’s degree in Healthcare Administration, Business Administration, Public Administration, or a related area, or equivalent practical experience.
• Master’s degree in the aforementioned fields is preferred.
• At least ten years in senior leadership roles within managed care, with extensive experience in enrollment, appeals, customer service, or provider network management.
• Strong familiarity with Medi-Cal and/or Medicare operations, and an understanding of factors influencing Medicare Star Ratings and healthcare quality metrics like HEDIS.
• Comprehensive knowledge of health plan regulations from DHCS, CMS, and other relevant authorities, including compliance management and appeals processes.

Benefits

• Competitive salary aligned with market trends and performance incentives.
• Comprehensive medical, vision, and dental coverage via CalPERS plans.
• Additional insurance coverage including life, accidental death, dismemberment, and long-term disability.
• Generous paid time off starting at 18 days annually, with options for cash-out and carryover, increasing with tenure.
• Flexible spending accounts for healthcare, dependent care, and transit expenses.
• Robust retirement benefits including CalPERS pension, discretionary plans, and deferred compensation options.
• Union representation for select roles through the Service Employees International Union.
• Wellness initiatives like on-site gym facilities, standing desks, farmers market access, and confidential round-the-clock counseling services.
• Financial planning resources and workshops, with opportunities to join a credit union.
• Support for professional development through tuition reimbursement and travel benefits.

Additional Information

This position operates on a hybrid basis, requiring work performed in or near San Jose, CA. The office is located at 6201 San Ignacio Ave, San Jose, CA 95119.