About Us
We are a growing multi-location outpatient healthcare organization in the San Francisco Bay Area.
We built our business around direct-pay plans of care, where patients commit to us directly and we must earn their trust, their business and every visit. We also work with Medicare and personal injury cases and are expanding into commercial insurance and medically integrated care.
That means operating two models simultaneously:
- A direct-pay model dependent on marketing, sales, patient trust and follow-through.
- An insurance model dependent on verification, documentation and collecting the correct amount at the correct time.
Most healthcare organizations are strong in one model or the other. We intend to be excellent at both.
What we do not currently have is one full-time person who owns how the business runs day to day, develops our managers and turns what works into something repeatable across locations.
That is this job.
This is a confidential search. Additional information about the organization will be shared with candidates selected to interview.
The Role
As Director of Operations, you will be the company’s full-time operator.
You will report to the CEO and work closely with an experienced fractional COO who has helped build and operate a medically integrated healthcare organization with approximately $20 million in annual revenue. The fractional COO will provide strategic guidance, financial review and coaching. You will own whether the work actually gets implemented.
You will lead managers responsible for clinical operations, front-office performance, patient intake and case management. You will also coordinate closely with marketing, finance and revenue-cycle leadership.
Your job is to:
- Run the day-to-day operating side of the company.
- Develop managers who can lead their own teams.
- Improve clinic-level profitability and performance.
- Understand and improve the patient-acquisition and sales pipeline.
- Establish consistent standards across locations.
- Build practical systems that continue working without your constant presence.
- Gradually assume responsibilities currently supported by the fractional COO.
This is both a building job and a running job.
Expect to spend regular time inside the clinics so you understand what is actually happening with patients and staff. The remainder of your time will be spent managing leaders, reviewing performance, solving problems and building the operating systems necessary for the company’s next stage.
If you only want to manage a floor, this position will eventually feel too broad. If you only want to develop strategy or build presentations, you will not succeed.
What You Will Own
Day-to-Day Operating Performance
- Run the company’s weekly operating rhythm.
- Maintain a clear scorecard for clinics, departments and managers.
- Translate company priorities into measurable outcomes, responsible owners and deadlines.
- Identify the most important operational constraints and drive them through resolution.
- Ensure commitments are completed without repeated follow-up from the CEO or fractional COO.
- Bring leadership conclusions, recommended actions and decision requests—not merely raw problems.
Managers and People
- Lead and develop the managers responsible for clinical and front-office operations.
- Set clear expectations, scorecards and decision authority for each leader.
- Help team leads grow into capable managers.
- Conduct direct, fair and timely performance conversations.
- Participate in hiring, onboarding, performance management and termination decisions.
- Improve staff retention without lowering performance standards.
- Build a management team that solves problems instead of escalating everything upward.
Developing managers will be one of the most important parts of this position. Success does not mean personally rescuing every department. It means making the people responsible for those departments more capable.
Clinic Operations
- Oversee scheduling, phones, patient flow and the front-office experience across locations.
- Establish consistent operating standards while allowing for legitimate differences among clinics.
- Monitor performance through both data and direct observation.
- Identify staffing, capacity and workflow constraints.
- Ensure improvements made in one clinic are transferred successfully to others.
- Hold managers accountable for maintaining agreed standards.
Patient Acquisition and Sales Pipeline
You will not be expected to personally create advertisements or manage media-buying platforms. You must, however, understand how marketing and sales produce revenue.
You will be responsible for understanding and improving the complete patient pipeline:
Lead → booked consultation → show → evaluation → recommendation → plan start → collection → retention
Responsibilities include:
- Monitoring lead response, booking and show rates.
- Improving intake and follow-up performance.
- Leading the teams responsible for converting inquiries into consultations.
- Improving consultation-to-plan conversion while protecting an ethical, patient-centered experience.
- Understanding why conversion changes rather than relying on assumptions.
- Connecting marketing activity to completed consultations, patient starts and collected revenue.
- Holding internal marketing team members and outside vendors accountable for agreed results.
- Aligning marketing volume with clinic capacity and intake performance.
Financial and Staffing Performance
- Review clinic-level revenue, expenses and contribution margin.
- Monitor payroll as a percentage of revenue.
- Build staffing models based on demand, operating hours and clinic capacity.
- Identify operational causes of financial underperformance.
- Develop and implement corrective action plans with the appropriate managers.
- Understand the financial impact of conversion, retention, labor, capacity and marketing performance.
- Work with the CEO and fractional COO to convert financial information into operating decisions.
You do not need CFO-level expertise. You must be financially literate enough to understand what is driving profitability and what management action is required.
Systems and Accountability
- Determine which recurring workflows require greater consistency.
- Build practical processes, training and documentation around those workflows.
- Improve handoffs among marketing, intake, case management, clinical teams and the front desk.
- Reduce dependence on individual memory and tribal knowledge.
- Use existing technology and automation to improve reliability and reduce manual work.
- Remove unnecessary steps, meetings and procedures when they do not improve the result.
- Build systems only after understanding the work they are intended to support.
Front-End Insurance Operations
- Ensure eligibility and benefits are verified before visits.
- Establish reliable workflows for authorizations and pre-visit requirements.
- Ensure patients receive accurate and understandable financial information.
- Improve collection of copays, deductibles and patient balances at the time of service.
- Reduce preventable billing problems caused by front-office errors.
- Coordinate with revenue-cycle leadership on payer-related workflows.
You will not personally own credentialing, coding, claims submission, payment posting or denial management. Dedicated revenue-cycle leadership will own those functions and help teach the relevant insurance requirements.
Growth and Replication
- Build an operating playbook for future locations.
- Define the staffing, training, technology and workflow requirements for expansion.
- Ensure new locations can reproduce the company’s strongest practices without depending on tribal knowledge.
- Help leadership determine when the organization is operationally ready to expand.
What Success Looks Like in the First Year
Specific targets will be established during the first 30 days, but successful performance will include:
- A consistent company scorecard and weekly operating rhythm.
- Clear accountability for every important business result.
- Stronger managers who independently solve problems and lead their teams.
- Improved clinic-level profitability and labor efficiency.
- Higher and more consistent new-patient booking and show rates.
- Improved consultation-to-plan conversion, with the drivers understood.
- Improved patient retention and plan completion.
- More consistent front-office execution across locations.
- Higher time-of-service collections and fewer preventable front-office errors.
- Reduced staff turnover and faster hiring for critical positions.
- Fewer recurring problems requiring CEO or fractional-COO intervention.
- A documented operating playbook capable of supporting future locations.
You will always know what you are being measured on.
Who We Are Looking For
This is an upper-mid-level operating role with the potential to grow into senior executive leadership.
The strongest candidate has already proven they can manage managers, own a meaningful budget or P&L and improve business performance. They are now ready for their first opportunity to run the operating side of an entire company.
You may be a fit if you have:
- Approximately four or more years of meaningful people-management experience.
- Managed team leads, supervisors or other managers—not only individual contributors.
- Responsibility for approximately 15–40 employees, directly and indirectly.
- Owned the performance of a substantial location, region, department or business unit.
- Managed a budget or P&L and understand labor, revenue and profitability.
- Improved sales, conversion, collections, retention or operating margin.
- Managed patient-facing or customer-facing hourly employees.
- Built systems, training or management rhythms rather than only following existing procedures.
- Worked in a direct-pay, membership, elective or consultation-based service model.
- The willingness to inspect calls, schedules, CRM pipelines, staffing and patient flow personally.
Multi-location experience is strongly preferred but not required. An exceptional operator who has successfully run a large, high-volume single location may be ready for this step.
Particularly relevant backgrounds include:
- Dental practices and dental groups
- Physical therapy
- Chiropractic or musculoskeletal care
- Med spas and elective healthcare
- Fertility
- Dermatology
- Optometry
- Podiatry
- Urgent care
- Veterinary groups
- Fitness or other multi-location, consultation-based service businesses
What You Do Not Need
You do not need:
- Previous COO or vice-president experience
- Deep insurance, credentialing, coding or billing expertise.
- Clinical licensure
- M&A, capital-raising or board-reporting experience.
- Personal expertise in media buying, copywriting or content creation.
- Comprehensive long-range strategy experience.
- Experience operating inside a large corporate infrastructure.
We can teach our clinical model, payer workflows and systems. Our fractional COO and revenue-cycle leadership will provide strategic and technical support.
What is much harder to teach is ownership, judgment, commercial awareness, people leadership and the willingness to get into the details.
The Person Who Will Thrive Here
You:
- Turn ambiguous problems into clear plans and completed results.
- Know which questions to ask even when no one gives you a task list.
- Understand that leads, conversion, collections and retention are operating issues.
- Can build structure without building bureaucracy.
- Are willing to listen to calls, inspect a schedule or trace a broken workflow personally.
- Address underperformance directly without unnecessary drama.
- Can move between financial results, patient experience, systems and people.
- Know when to enter the details and when to coach a manager to own them.
- Are strategic enough to prioritize but operational enough to execute.
- Want the opportunity to grow into a larger leadership position by producing measurable results.
This Job Is Not for You If
- You want to work remotely and rarely visit the clinics.
- You prefer advising people to personally owning the result.
- You avoid difficult performance conversations.
- You need someone to provide a detailed task list.
- You report problems without investigating their causes or recommending action.
- You believe more policies, meetings and SOPs are always the answer.
- You are uncomfortable with ambiguity or changing priorities.
- You want to remain above the details.
- You have only worked in large organizations with extensive support departments.
Career Path
The fractional COO will initially provide substantial coaching and strategic support. As you demonstrate command of the business, you will assume increasing responsibility for operating performance, financial review and cross-functional decision-making.
The person who successfully builds and runs the operating system for the company will be the natural candidate to progress into Head of Operations or COO responsibility as the organization grows.
That progression is not automatic or based solely on tenure. It will depend on your ability to:
- Produce measurable operating and financial improvements.
- Develop managers who can lead without constant intervention.
- Identify and resolve cross-functional problems.
- Bring senior leadership conclusions and recommendations rather than undiagnosed problems.
- Operate the company with decreasing reliance on the fractional COO.
Compensation and Benefits
- Base salary of $100,000–$130,000, depending on experience.
- Performance bonus opportunities
- Health benefits.
- Paid time off.
- Employee and family wellness benefit.
Pay: $100,000.00 - $130,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Application Question(s):
- What attracted you to this role, and why are you a good fit?
Work Location: Hybrid remote in Fremont, CA 94539
