Overview
Morgan Consulting Resources, Inc. has been retained to confidentially search for a
Director of Operations
for a Texas Department licensed Third Party Administrator (TPA) and Management Service Organization (MSO). This position will work on-site in Houston, TX. Relocation assistance is available for qualifying candidates. Scope and Impact
This is a role for an operator who wants real ownership, real impact, and a seat at the table where decisions turn into execution. As Director of Operations, you step into a hands-on leadership position with enterprise visibility across claims, medical management, provider network operations, quality, analytics, and member services, translating strategy into measurable performance and better outcomes. You will work closely with functional leaders, technology and data teams, and executive leadership to simplify complexity, improve workflows, and scale a growing MSO in a highly regulated environment, while staying tightly connected to the business and the results. For leaders who enjoy building, fixing, and optimizing systems, partnering across functions, and being accountable for performance, this role offers a rare combination of scope, influence, and the opportunity to leave a clear operational fingerprint on the organization’s growth and success. About the Position
Reporting to the President, the Director of Operations is responsible for day-to-day execution and performance management of a Texas-based MSO. This role provides operational oversight of delegated functions to operate efficiently, compliantly, and in alignment with financial and quality objectives, with a strong focus on claims operations, medical management workflows, provider network operations, quality support, data integrity, and a member services call center function. The Director of Operations partners with functional Directors to support enterprise MSO operational integration and shared performance outcomes, while functional Directors retain ownership of domain expertise and strategy. The role translates leadership direction into clear workflows, shared performance metrics, and accountability across departments, supporting compliance with delegated health plan requirements related to utilization management, claims timeliness and accuracy, grievances and appeals coordination with client health plans, RAF support, and service-level expectations. Fosters relationships with client health plans for collaboration of services and serves as the representative of joint operations management. This is a hands-on leadership role, suited for an operator who can manage complexity, troubleshoot issues, and drive consistent execution across a lean, growing organization. This role supports the company’s technology enablement model by partnering with internal and external solution providers to improve operational performance and scalability. Key Responsibilities
Operational Leadership
Provide enterprise operational leadership across Claims, Medical Management, Provider Network Operations, Quality/STAR, Analytics, and Member Services, working in partnership with functional Directors to ensure coordinated execution and performance. Execute leadership-defined strategic goals through measurable operational initiatives that improve medical loss ratio (MLR), reduce avoidable utilization, and enhance care coordination. In collaboration with Compliance, support efforts to maintain alignment so that delegated functions meet CMS, NCQA, and state regulatory standards on an ongoing basis. (e.g., UM timeliness, claims accuracy and timeliness, grievance/appeal coordination with plans, provider dispute resolution compliance, encounter data accuracy). Develop and monitor KPIs across each service line to measure and drive improvements for timely authorizations, accurate claims adjudication, and effective vendor performance. Collaborate with technology and data teams to automate workflows and improve operational scalability. Medical Management Oversight
Support the Director of Medical Management in maintaining regulatory and delegated-contract compliance for Utilization Management (UM), including oversight of UM reporting requirements, audit preparation, timeliness monitoring, and documentation. Oversee operational workflows to meet CMS, NCQA, and health-plan delegated standards. Collaborate with the Director and UM Medical Director to assess opportunities for improvement on access to care, medical loss ratio, and quality-of-care trends related to medical management functions. Integrate operations and clinical teams to manage total cost of care and improve member outcomes. Customer Service Operations
Direct responsibility for customer call centers for both inbound and outbound calls. Oversight and support of Manager to monitor KPI metrics to include average speed to answer, call abandonment rate, hold time, and member and provider scripts are compliant. Financial and Performance Management
Collaborate with MSO leadership on budget development, performance dashboards, and cost-containment strategies tied to PMPM and MLR goals. Identify process improvements and automation opportunities that reduce administrative cost ratio (ACR) while improving service delivery. Support cross-functional initiatives to achieve targeted EBITDA and shared-savings benchmarks through operational execution and performance management. Provider Network & Relations
Support the Director, Provider Network Operations. In collaboration, oversee provider credentialing operations, provider onboarding, and operational implementation of executed provider contracts to support network adequacy, data accuracy, and timely roster submission. Support provider contracting activities by reviewing proposed contract terms for operational feasibility and driving timely implementation of operational, reporting, and compliance requirements once agreements are executed. Drive provider engagement initiatives focused on VBC performance, documentation improvement, and care coordination compliance. Collaborate in the development or revision of incentive programs aligning PCP and specialist behavior with quality, utilization, and financial goals. Contract negotiation authority and final contract execution remain with executive leadership and legal counsel. Reporting Analytics, Quality, Compliance & Risk Adjustment
Support the Director, Reporting Analytics to promote integration of Quality and Risk Adjustment programs with operations, supporting accurate HCC capture, care gap closure, and STAR performance > 4.0. Partner with the Compliance Officer to maintain readiness for CMS audits, delegation oversight reviews, and data validation. Implement continuous quality improvement (CQI) methodologies and corrective action plans. Develop and implement reporting tools as needed by organizational departments supporting business requirements. Leadership
Lead, mentor, and development of department directors and managers; promote accountability, transparency, and performance-based culture. Represent Operations in executive meetings, board reporting, and plan-partner discussions. Foster an environment of collaboration between all teams. Qualifications
Bachelor’s degree in Healthcare Administration, Business, or related field (Master’s preferred). Minimum ten (10) years of progressive leadership experience in healthcare operations, with at least five (5) years in Medicare Advantage, global risk, or delegated MSO settings. Demonstrated expertise in: CMS Part C operations and compliance, Utilization and Care Management programs, Claims and encounter data integrity, Quality/STAR performance improvement, and Revenue Cycle Management/Risk Adjustment and documentation for diagnosis capture/recapture. Strong financial acumen and understanding of PMPM, MLR, and EBITDA drivers. Proven success leading cross-functional teams in complex, regulated environments. Excellent communication, analytical, and organizational skills. Ability to collaborate effectively with physicians, health plans, and regulatory agencies. About the Company’s Culture
This company fosters a collaborative, inclusive, and performance-driven culture grounded in respect, accountability, and innovation. The organization emphasizes teamwork, continuous improvement, and a professional, engaging work environment, with leaders expected to model these values and drive operational excellence across departments. This organization is committed to equal access and opportunity in employment and the workplace, maintaining an inclusive environment free from discrimination based on race, color, creed, religion, national origin, gender, age, marital status, disability, public assistance status, veteran status, sexual orientation, gender identity, or gender expression. Presented by Erica Eikelboom, Principal & Executive Search Consultant Morgan Consulting Resources erica@morganconsulting.com
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Morgan Consulting Resources, Inc. has been retained to confidentially search for a
Director of Operations
for a Texas Department licensed Third Party Administrator (TPA) and Management Service Organization (MSO). This position will work on-site in Houston, TX. Relocation assistance is available for qualifying candidates. Scope and Impact
This is a role for an operator who wants real ownership, real impact, and a seat at the table where decisions turn into execution. As Director of Operations, you step into a hands-on leadership position with enterprise visibility across claims, medical management, provider network operations, quality, analytics, and member services, translating strategy into measurable performance and better outcomes. You will work closely with functional leaders, technology and data teams, and executive leadership to simplify complexity, improve workflows, and scale a growing MSO in a highly regulated environment, while staying tightly connected to the business and the results. For leaders who enjoy building, fixing, and optimizing systems, partnering across functions, and being accountable for performance, this role offers a rare combination of scope, influence, and the opportunity to leave a clear operational fingerprint on the organization’s growth and success. About the Position
Reporting to the President, the Director of Operations is responsible for day-to-day execution and performance management of a Texas-based MSO. This role provides operational oversight of delegated functions to operate efficiently, compliantly, and in alignment with financial and quality objectives, with a strong focus on claims operations, medical management workflows, provider network operations, quality support, data integrity, and a member services call center function. The Director of Operations partners with functional Directors to support enterprise MSO operational integration and shared performance outcomes, while functional Directors retain ownership of domain expertise and strategy. The role translates leadership direction into clear workflows, shared performance metrics, and accountability across departments, supporting compliance with delegated health plan requirements related to utilization management, claims timeliness and accuracy, grievances and appeals coordination with client health plans, RAF support, and service-level expectations. Fosters relationships with client health plans for collaboration of services and serves as the representative of joint operations management. This is a hands-on leadership role, suited for an operator who can manage complexity, troubleshoot issues, and drive consistent execution across a lean, growing organization. This role supports the company’s technology enablement model by partnering with internal and external solution providers to improve operational performance and scalability. Key Responsibilities
Operational Leadership
Provide enterprise operational leadership across Claims, Medical Management, Provider Network Operations, Quality/STAR, Analytics, and Member Services, working in partnership with functional Directors to ensure coordinated execution and performance. Execute leadership-defined strategic goals through measurable operational initiatives that improve medical loss ratio (MLR), reduce avoidable utilization, and enhance care coordination. In collaboration with Compliance, support efforts to maintain alignment so that delegated functions meet CMS, NCQA, and state regulatory standards on an ongoing basis. (e.g., UM timeliness, claims accuracy and timeliness, grievance/appeal coordination with plans, provider dispute resolution compliance, encounter data accuracy). Develop and monitor KPIs across each service line to measure and drive improvements for timely authorizations, accurate claims adjudication, and effective vendor performance. Collaborate with technology and data teams to automate workflows and improve operational scalability. Medical Management Oversight
Support the Director of Medical Management in maintaining regulatory and delegated-contract compliance for Utilization Management (UM), including oversight of UM reporting requirements, audit preparation, timeliness monitoring, and documentation. Oversee operational workflows to meet CMS, NCQA, and health-plan delegated standards. Collaborate with the Director and UM Medical Director to assess opportunities for improvement on access to care, medical loss ratio, and quality-of-care trends related to medical management functions. Integrate operations and clinical teams to manage total cost of care and improve member outcomes. Customer Service Operations
Direct responsibility for customer call centers for both inbound and outbound calls. Oversight and support of Manager to monitor KPI metrics to include average speed to answer, call abandonment rate, hold time, and member and provider scripts are compliant. Financial and Performance Management
Collaborate with MSO leadership on budget development, performance dashboards, and cost-containment strategies tied to PMPM and MLR goals. Identify process improvements and automation opportunities that reduce administrative cost ratio (ACR) while improving service delivery. Support cross-functional initiatives to achieve targeted EBITDA and shared-savings benchmarks through operational execution and performance management. Provider Network & Relations
Support the Director, Provider Network Operations. In collaboration, oversee provider credentialing operations, provider onboarding, and operational implementation of executed provider contracts to support network adequacy, data accuracy, and timely roster submission. Support provider contracting activities by reviewing proposed contract terms for operational feasibility and driving timely implementation of operational, reporting, and compliance requirements once agreements are executed. Drive provider engagement initiatives focused on VBC performance, documentation improvement, and care coordination compliance. Collaborate in the development or revision of incentive programs aligning PCP and specialist behavior with quality, utilization, and financial goals. Contract negotiation authority and final contract execution remain with executive leadership and legal counsel. Reporting Analytics, Quality, Compliance & Risk Adjustment
Support the Director, Reporting Analytics to promote integration of Quality and Risk Adjustment programs with operations, supporting accurate HCC capture, care gap closure, and STAR performance > 4.0. Partner with the Compliance Officer to maintain readiness for CMS audits, delegation oversight reviews, and data validation. Implement continuous quality improvement (CQI) methodologies and corrective action plans. Develop and implement reporting tools as needed by organizational departments supporting business requirements. Leadership
Lead, mentor, and development of department directors and managers; promote accountability, transparency, and performance-based culture. Represent Operations in executive meetings, board reporting, and plan-partner discussions. Foster an environment of collaboration between all teams. Qualifications
Bachelor’s degree in Healthcare Administration, Business, or related field (Master’s preferred). Minimum ten (10) years of progressive leadership experience in healthcare operations, with at least five (5) years in Medicare Advantage, global risk, or delegated MSO settings. Demonstrated expertise in: CMS Part C operations and compliance, Utilization and Care Management programs, Claims and encounter data integrity, Quality/STAR performance improvement, and Revenue Cycle Management/Risk Adjustment and documentation for diagnosis capture/recapture. Strong financial acumen and understanding of PMPM, MLR, and EBITDA drivers. Proven success leading cross-functional teams in complex, regulated environments. Excellent communication, analytical, and organizational skills. Ability to collaborate effectively with physicians, health plans, and regulatory agencies. About the Company’s Culture
This company fosters a collaborative, inclusive, and performance-driven culture grounded in respect, accountability, and innovation. The organization emphasizes teamwork, continuous improvement, and a professional, engaging work environment, with leaders expected to model these values and drive operational excellence across departments. This organization is committed to equal access and opportunity in employment and the workplace, maintaining an inclusive environment free from discrimination based on race, color, creed, religion, national origin, gender, age, marital status, disability, public assistance status, veteran status, sexual orientation, gender identity, or gender expression. Presented by Erica Eikelboom, Principal & Executive Search Consultant Morgan Consulting Resources erica@morganconsulting.com
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