Chief Operating Officer (COO) - Virginia Community & State Medicaid Health Plan - Remote

Primary Responsibilities

• Leads relationship management on all Operations related areas for the Cardinal Care program with the DMAS and all other State government agencies who have regulatory oversight of elements of the Cardinal Care/DSNP program to influence program design, develop support for program efforts, and secure approvals.
• Leads and oversees core health plan operations (provider & member related, network, IT, claims, etc.) ensuring effective implementation of all Cardinal Care contract requirements across covered populations, regions, and services.
• Translates enterprise strategy and DMAS commitments into clear operational priorities, workflows, performance metrics, and accountability structures.
• Ensures operational consistency and scalability across regions while supporting local engagement and region specific execution aligned with DMAS expectations.
• Maintains operational readiness for DMAS, CMS, EQRO, operational, and financial audits, ensuring timely, accurate, and coordinated responses.
• Supports ongoing review and implementation of contract amendments and policy updates in coordination with DMAS.
• Provides operational oversight and support for care management, care coordination, behavioral health integration, LTSS operations, and population specific programs, ensuring alignment with Cardinal Care delivery models.
• Collaborates with the CMO and clinical leaders to ensure operational infrastructure supports quality improvement, clinical outcomes, and member experience goals.
• Oversees operational functions supporting provider network performance, member services, grievances and appeals, enrollment support, and service delivery performance, ensuring operations are structured to support provider engagement, timely issue resolution, and service accessibility across all regions of the Commonwealth.
• Establishes and monitors operational KPIs, dashboards, and management routines tied to quality, compliance, financial stewardship, and stakeholder satisfaction.
• Leads continuous improvement initiatives to enhance efficiency, reduce operational risk, and improve service reliability while maintaining compliance.

Required Qualifications

• 5+ years of experience working with FQHCs, Community Based Organizations, and State regulatory agencies.
• 5+ years of experience working in Managed Medicaid.
• 5+ years of experience leading operations, strategic planning, and development.
• Ability to handle ambiguity.
• Ability to travel up to 50% throughout the State of Virginia.

Preferred Qualifications

• Executive level experience in dealing with multiple State Agencies.
• Reside in Virginia.