Director, Operations
Company: Gold Coast Health Plan
Location: Camarillo
Posted on: April 1, 2026
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Job Description:
This position is intended to start January 2026. The pay range
above represents the minimum and maximum rate for this position in
California. Factors that may be used to determine where newly hired
employees will be placed in the pay range include the employee
specific skills and qualifications, relevant years of experience
and comparison to other employees already in this role. Most often,
a newly hired employee will be placed below the midpoint of the
range. Salary range will vary for remote positions outside of
California and future increases will be based on the pay band for
the city and state you reside in. Work Culture: GCHP strives to
create an inclusive, highly collaborative work culture where our
people are empowered to grow and thrive. This philosophy enables us
to create the health plan of the future and do our best work –
Together. GCHP promotes a flexible work environment. Employees may
work from a home location or in the GCHP office for all or part of
their regular workweek (see disclaimer). GCHP’s focuses on 5 Core
Values in the workplace: • Integrity • Accountability •
Collaboration • Trust • Respect Disclaimers: • Flexible work
schedule is based on job duties, department, organization, or
business need. • Gold Coast Health Plan will not sponsor applicants
for work visas. POSITION SUMMARY The Director, Operations, in
collaboration with the Chief Operating Officer and colleagues, is
responsible for the strategic direction and management of daily
operations for Oversight, PDRs, Payment Integrity (PI), Joint
Operations Meetings (JOMs), JQRs, Regulatory Reporting, and the
management of various outsourced services, including but not
limited to, mail room processing and recoveries. The successful
candidate will assist in implementing the organization’s strategic
goals, by directing the implementation of new programs and systems,
developing, and maintaining policies and procedures and ensuring
regulatory/contractual compliance. This position plays a key
leadership role, interacting with all levels of Gold Coast Health
Plan (GCHP) staff and external stakeholders, including the Ventura
County Medi-Cal Managed Care Commission, executive staff, members,
providers, network management, legal counsel, State and Federal
representatives and representatives of other agencies.
Distinguishing Characteristics: Responsible for overall policy
development, program planning, fiscal management, administration,
and operation of assigned Plan functions, programs, and activities.
The Director of Operations is responsible for accomplishing goals
and objectives and for ensuring that the area served is provided
with desired and mandated services in an efficient and effective
manner. Amount of Travel Required: 30% Work Schedule: Work
protracted and irregular hours and evening meetings or work unusual
hours for meeting attendance or participation in specific projects
or programs. Reasonable Accommodations Statement To accomplish this
job successfully, an individual must be able to perform, with or
without reasonable accommodation, each essential function
satisfactorily. Reasonable accommodations may be made to help
enable qualified individuals with disabilities to perform the
essential functions. ESSENTIAL FUNCTIONS Job Function &
Responsibilities • Responsible for strategic direction and daily
management of key operations areas - Vendor Management, Encounter
Processing, Recoveries, Payment integrity, and ensures the
development and management of performance measurement, management
controls, critical success factors and key performance indicators.
• Vendor Management is a key responsibility of this position. The
candidate will be expected to become familiar with all aspects of
the outsourcing contracts and manage the GCHP vendor partners
ensuring that all operational functions are managed in accordance
with contract terms, regulatory requirements, and industry
standards. • Establish and ensure adherence to Medi-Cal, Medicare,
DSNP and GCHP policies and procedures for all functional areas of
responsibility. • Work with the Executive Leader to develop plans
for systems and staffing to meet current and future programs,
requirements, and initiatives. • Reviews plans and budgets of
assigned departments monthly and as part of the annual planning
process. • Facilitate data-driven decision making across
operational areas that leads to meaningful actions. • Implement new
initiatives and resolve problems that cross multiple departments by
forming ad-hoc workgroups and assessing intangible variables,
automated processes, manual workflows, and impact to providers and
members. • Work closely with staff, vendors, and peers to set
goals, clearly define operations, and develop appropriate
performance standards, metrics and reporting tools. • Oversee the
integration of operational departments to maximize the effective
use of all resources towards meeting established goals, compliance
and quality requirements, and policies and procedures. • Develops
and maintains policies and procedures to meet goals and ensure
regulatory/contractual compliance; collaborates in managing
regulatory audits and inquiries. • Serves as the agency authority
on Operations Oversight, Operational Analytics and/or Joint
Operating Meetings • Develop and direct supervisory development and
training, including continuous improvement of knowledge and skill
levels of all assigned staff • Collaborate with internal and
external customers and stakeholders to resolve issues and enhance
relationships. Ensures the organization and its mission, programs,
products and services are consistently presented in a strong,
positive image. POSITION QUALIFICATIONS SKILLS & ABILITIES
Education: • Bachelor’s degree (four-year college or technical
school) Preferred, Field of Study: Business, Health Care or Public
Administration or Equivalent Work Experience • Previous experience
dealing with Government programs, both Medicaid and Medicare.
Knowledge of Managed Care, particularly Medi-Cal, Medicare and
DSNP, is desired: or Work Equivalent Experience: At least 7 (seven)
years of experience in Operations Management Computer Skills:
Advanced computer skills included in MS Office products.
Certifications & Licenses: A valid and current Driver's License,
Auto Insurance, and professional licensure(s) Other Requirements: •
Business principles and techniques of administration, organization,
and management to include an in-depth understanding of the key
business issues that exist in the health care industry. •
Communicate effectively in writing, orally, and with others to
convey information, in a manner consistent with job functions.
Competency Statements • Leadership - Ability to influence others to
perform their jobs effectively and to be responsible for making
decisions. • Management Skills - Ability to organize and direct
oneself and effectively supervise others. • Business Acumen -
Ability to grasp and understand business concepts and issues. •
Decision Making - Ability to make critical decisions while
following company procedures. • Presentation Skills - Ability to
effectively present information publicly. • Negotiation Skills -
Ability to reach outcomes that gain the support and acceptance of
all parties. • Diversity Oriented - Ability to work effectively
with people regardless of their age, gender, race, ethnicity,
religion, or job type.
Keywords: Gold Coast Health Plan, Tustin , Director, Operations, Logistics, Transportation & Drivers , Camarillo, California
