Remote Operations Jobs in Portland, ME (NOW HIRING)

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of"people caring for people," Martin's Point employees are on amission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.

Position Summary
 The Senior Vice President (SVP), Operations is a key member of the Senior Leadership team responsible for leading operational strategy and execution across the Health Plan.
Reporting directly to the Chief Operating Officer, the SVP serves as a strategic and transformational leader, ensuring organizational priorities are translated into measurable operational outcomes that advance the organization's mission, financial sustainability, member experience, provider partnerships, and market competitiveness.
The SVP will oversee critical functions including Health Plan Operations (Claims and Member Services), Value-Based Care Strategy and Provider Engagement, Risk Adjustment, Health Plan Strategic Initiatives, Product Strategy and Management, Network Strategy and Performance, and Provider Contracting. This leader will drive cross-functional alignment and execution across the organization while fostering strong partnerships with the Delivery System, Clinical Leadership, Finance, Technology, and other Shared Services functions.
Job Description

PRIMARY DUTIES AND RESPONSIBILITIES

• Operations Strategy & Execution
  • Partners with the COO and Leadership Team to develop and execute organizational strategic priorities.
  • Translates strategic objectives into operational plans, initiatives, and measurable outcomes.
  • Ensures enterprise-wide alignment, accountability, and execution of key strategic initiatives.
  • Leads cross-functional efforts to advance organizational growth, operational effectiveness, and market competitiveness.
  • Serves as a key advisor to the COO on operational performance, business opportunities, emerging risks, and strategic investments.
  • Establishes governance structures and performance management processes to monitor strategic execution.
• Health Plan Operations Leadership
  • Provides executive oversight for core health plan operational functions, including:
    • Claims Operations
      • Drives operational excellence, accuracy, efficiency, and regulatory compliance.
      • Improves claims processing performance, provider satisfaction, and administrative cost effectiveness.
      • Leads modernization and automation efforts to enhance operational scalability.
    • Member Services and Member Experience
      • Establishes service strategies that improve member satisfaction and retention.
      • Drives performance through service excellence, operational efficiency, workforce optimization, and digital capabilities.
      • Ensures a member-centric culture across all operational teams.
• Value-Based Care Strategy & Provider Engagement
  • Leads development and execution of enterprise value-based care strategies.
  • Partners with clinical and delivery system leaders to advance population health, quality performance, and total cost of care initiatives.
  • Collaborates with provider organizations to improve quality outcomes, affordability, and care management performance.
  • Oversees provider education and engagement programs supporting value-based contracts and performance improvement initiatives.
  • Drives operational integration between payer and provider functions to achieve strategic goals.

• Risk Adjustment & Revenue Optimization
  • Provides executive oversight of enterprise risk adjustment strategy and performance.
  • Ensures effective collaboration across clinical, operational, analytics, and provider teams.
  • Advances coding accuracy, documentation improvement, and risk capture initiatives.
  • Monitors financial performance and regulatory compliance related to risk adjustment programs.
  • Identifies opportunities to strengthen organizational revenue performance through improved risk management strategies.
• Product Strategy & Management
  • Leads health plan product strategy, development, lifecycle management, and performance.
  • Partners with Sales, Marketing, Actuarial, Finance, and Clinical leadership to ensure competitive product offerings.
  • Evaluates market opportunities and emerging trends to support growth and innovation.
  • Drives product performance through disciplined execution, financial management, and customer insights.
• Network Strategy, Performance & Contracting
  • Oversees provider network strategy, network performance management, and provider contracting functions.
  • Ensures network adequacy, affordability, quality, and strategic alignment with organizational goals.
  • Leads development and negotiation of provider reimbursement arrangements, including value-based payment models.
  • Strengthens strategic provider relationships and foster collaborative partnerships.
  • Supports integration and alignment with the organization's delivery system and affiliated provider organizations.
• Operational Excellence & Transformation
  • Leads enterprise-wide operational improvement initiatives focused on efficiency, scalability, affordability, quality, and service.
  • Champions continuous improvement methodologies and performance management disciplines.
  • Leverages analytics, technology, automation, and innovation to optimize operations.
  • Builds organizational capabilities that support future growth and changing market demands.
  • Leads significant organizational change initiatives while maintaining employee engagement and operational performance.
• Financial & Business Leadership
  • Assumes accountability for operational and financial performance across assigned functions.
  • Partners closely with Finance to develop budgets, forecasts, business cases, and investment strategies.
  • Drives disciplined resource allocation and cost management initiatives.
  • Utilizes data and analytics to support strategic decision-making and performance improvement.
  • Ensures operational initiatives contribute to organizational financial sustainability and growth.
• Leadership & Talent Development
  • Leads, mentors, and develops a high-performing team of operational and business leaders.
  • Fosters a culture of accountability, collaboration, innovation, inclusion, and continuous improvement.
  • Builds leadership capability throughout the organization.
  • Successfully leads teams through organizational transformation and change.
  • Serves as a visible, trusted, and influential senior leader.

Employees are expected to work consistently to demonstrate the mission, vision, and core values of the organization.

POSITION QUALIFICATIONS

Education:

• Bachelor's degree in Business Administration, Healthcare Administration, Finance, Public Health, or related field.
• Master's degree in Business Administration (MBA), Healthcare Administration (MHA), Public Health (MPH), Finance, or related field.

Licensure/certification:

• Lean, Six Sigma, or operational excellence certification preferred.

Experience:

• Minimum of 15 years of progressive healthcare leadership experience including leading large-scale health plan, payer, integrated delivery system, or healthcare operations functions required.
• Experience within integrated payer-provider organizations preferred.
• Demonstrated success leading value-based care and population health initiatives preferred.
• Experience with Medicare Advantage, Medicaid, Commercial, and Government Programs preferred.
• Experience leading provider contracting and network strategy functions preferred.

Knowledge:

• Deep understanding of health plan operations, value-based care, provider reimbursement, network management, and healthcare economics.
• Strong financial acumen and demonstrated ability to drive operational and financial performance.

Skills:

• Demonstrated success leading enterprise strategic initiatives and organizational transformation efforts.
• Exceptional analytical, strategic thinking, and problem-solving capabilities.
• Outstanding executive communication and stakeholder management skills.

Abilities:

• Proven experience leading through significant organizational change and complexity.

This position is not eligible for immigration sponsorship.

We are an equal opportunity/affirmative action employer.

Martin's Point complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact jobinquiries@martinspoint.org

Do you have a question about careers at Martin's Point Health Care? Contact us at:jobinquiries@martinspoint.org