Position Overview:
Empower. Unite. Care.
MetroPlus Health is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. Reporting to the President & Chief Executive Officer, the Chief Administrative Officer (CAO) serves as a senior executive responsible for the strategic leadership, integration, and operational performance of critical administrative and health plan functions. The CAO provides enterprise oversight of Claims, Provider Network Operations, Facilities Operations, Provider Contracting, Provider Credentialing, Core IT Systems Operations, Provider Data Management, Vendor Management, Payment Integrity, and Enrollment & Membership. The role establishes a unified operating model across these functions to strengthen service delivery, regulatory compliance, financial stewardship, data integrity, technology reliability, and the experience of members, providers, employees, and business partners. As a member of the executive leadership team, the CAO translates organizational strategy into measurable operating plans, builds accountable leadership teams, manages enterprise risk, and advances continuous improvement across MetroPlusHealth. Scope of Role & Responsibilities Provide executive leadership and strategic direction for Claims, Provider Network Operations, Facilities Operations, Provider Contracting, Provider Credentialing, Core IT Systems Operations, Provider Data Management, Vendor Management, Payment Integrity, and Enrollment & Membership. Translate MetroPlusHealth's strategic priorities into integrated divisional objectives, operating plans, performance measures, budgets, and accountability structures. Build, coach, and retain a high-performing leadership team; clarify decision rights, strengthen succession planning, and promote collaboration across operational, clinical, financial, technology, legal, compliance, and regulatory functions. Establish an enterprise operating rhythm that includes performance reviews, risk escalation, issue resolution, portfolio prioritization, and transparent reporting to the President & Chief Executive Officer and other governance bodies, as requested. Ensure assigned functions operate in accordance with applicable federal, New York State, New York City, contractual, accreditation, privacy, security, and corporate requirements, in partnership with Legal, Compliance, Human Resources, Information Security, Finance, and Internal Audit. Oversee the end-to-end claims administration strategy, including accurate and timely adjudication, adjustments, quality assurance, payment integrity coordination, provider inquiry resolution, appeals support, testing, training, delegated activities, and remediation of systemic issues. Direct modernization and continuous improvement of claims operations through automation, analytics, standardized controls, root-cause analysis, and cross-functional resolution of configuration, authorization, eligibility, contract, and provider data issues. Lead Provider Network Operations to support network maintenance and expansion, provider relations, education, engagement, issue resolution, communications, service performance, and collaboration with clinical and regulatory partners. Provide executive oversight of provider contracting strategy and operations, including provider recruitment, negotiation, contract administration, value-based and other strategic arrangements, implementation readiness, and coordination of contractual terms with claims and provider data systems. Oversee credentialing and re-credentialing operations, including delegated credentialing oversight, provider application review, data quality, documentation, timeliness, and adherence to established standards and requirements. Ensure Provider Data Management maintains complete, accurate, timely, and synchronized provider records across source systems, directories, claims platforms, contracting workflows, and downstream applications. Establish governance for provider life-cycle management so that contracting, credentialing, network operations, provider data, claims configuration, and communications function as one coordinated process. Oversee Core IT Systems Operations supporting health plan administration, with a focus on availability, stability, production support, release readiness, incident and problem management, configuration integrity, access controls, change governance, disaster recovery coordination, and service continuity. Partner with the Chief Information Officer, Information Security, business owners, and technology teams to align core-system roadmaps, investments, integrations, and operating priorities with enterprise needs. Direct Facilities Operations to provide safe, functional, efficient, and accessible workplaces; oversee space planning, maintenance, office services, physical asset coordination, emergency preparedness, and business continuity support. Lead enterprise Vendor Management for assigned vendors, including due diligence coordination, performance standards, service-level agreements, risk assessment, contract compliance, financial oversight, issue escalation, remediation, renewal, and transition planning. Oversee the end-to-end Enterprise-level Payment Integrity (PI) program and performance management functions as well as responsibility for analysis of medical payment rates and fee schedules. Will assure optimization of pre/post claim editing, audit and claim recovery programs that will drive incremental value year over year. Serves as the strategic leader responsible for overseeing Enrollment Operations. Must provide leadership to ensure the accurate administration, implementation, reconciliation, and operational performance of MetroPlusHealth’s enrollment processes across all product lines. Develop and maintain key performance indicators, dashboards, quality controls, and management reporting that provide timely insight into service, productivity, accuracy, cost, compliance, system performance, vendor performance, and stakeholder experience. Own the development and execution of the division's annual operating and capital budgets; monitor expenses, productivity, staffing, contracts, and investments to achieve responsible stewardship and sustainable results. Lead operational readiness for new products, regulatory requirements, major system changes, vendor transitions, network initiatives, acquisitions, and other enterprise priorities affecting assigned functions. Establish effective internal controls, documentation standards, policies, procedures, training, quality assurance, audit readiness, and corrective action processes throughout the portfolio. Identify, assess, and mitigate operational, financial, technology, compliance, vendor, and continuity risks; escape material risks promptly and ensure corrective actions are completed and sustained. Serve as an executive liaison with NYC Health + Hospitals, government agencies, regulators, providers, vendors, auditors, and other external stakeholders, as appropriate to the portfolio. Promote a culture of integrity, accountability, inclusion, service, innovation, and continuous learning aligned with MetroPlusHealth's mission and values. Perform other duties and lead special initiatives as assigned by the President & Chief Executive Officer. Required Education, Training & Professional Experience Bachelor's degree in health care administration, business administration, public administration, finance, information systems, or a related field required; master's degree or other advanced degree strongly preferred. Minimum of ten (10) years of progressively responsible leadership experience in managed care, health plan administration, health care operations, or a comparably complex regulated environment. Demonstrated leadership experience in several of the following areas: claims administration, provider network operations, provider contracting, credentialing, provider data, core health plan systems, facilities, and vendor management. Comprehensive knowledge of managed care operations and the interdependencies among provider contracts, credentialing, provider data, benefits and claims configuration, claims payment, technology platforms, and provider service. Demonstrated success improving service, quality, cost, compliance, controls, data integrity, and operational performance through process redesign, technology enablement, and disciplined performance management. Experience managing outsourced or delegated functions, complex vendor relationships, service-level agreements, remediation plans, and contract performance. Strong financial and business acumen, including operating and capital budgeting, workforce planning, investment prioritization, business cases, and benefit realization. Experience leading through significant change and influencing executive, technical, clinical, regulatory, and operational stakeholders in a matrixed organization. Working knowledge of federal and New York State laws, regulations, contractual requirements, and industry standards applicable to managed care operations preferred. Required Licensure and/or Certification Relevant professional certification, such as FACHE, PMP, Lean Six Sigma, CHC, or a comparable operations, technology, compliance, or health care credential, is preferred. Professional Competencies Integrity and Trust Enterprise Leadership and Strategic Agility Operational Excellence and Results Orientation Managed Care and Health Plan Operations Expertise Financial Acumen and Resource Stewardship Risk Management, Regulatory Compliance, and Internal Controls Technology, Data, and Digital Transformation Leadership Provider, Member, and Customer FocusVendor and Contract Governance Change Leadership and Continuous Improvement Talent Development, Collaboration, and Influence Executive Written and Oral Communication Sound Judgment, Decision Quality, and Problem Solving#LI-Hybrid#MPH50
