Fractional Head of Operations (COO-level)
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Skills
About the role
About Kinstead
Kinstead Health makes it possible for experienced nurse practitioners to own independent, insurance-based practices. NPs own their practice; we run everything that usually stops them: entity formation, credentialing and payer contracts, billing and revenue cycle, the EHR, phones, scheduling and patient acquisition. Our promise to NPs: start your practice in 60 days, get paid on a guaranteed per-visit rate, and keep your clinical independence.
50+ nurse practitioners across Massachusetts, Maryland and Connecticut, expanding along the East Coast
New practices launching every week, with strong inbound demand from NPs
Monthly patient visits up 3x in a single quarter (June to September 2026)
Our own technology platform: every practice is moving onto Kinstead-built EHR and billing infrastructure
The opportunity
Kinstead has found fit with NPs; the next chapter is scale. We're launching practices every week, adding payers and states, and launching new products for practice owners regularly. We want a seasoned operator to design how Kinstead runs at 200+ practices, and to build it now, while the foundation is being set up.
Kinstead has found fit with NPs; the next chapter is scale. We're launching practices every week, adding payers and states, and moving the network onto our own practice management + EHR platform. We want a seasoned operator to design how Kinstead runs at 200+ practices, and to build it now, while the foundation is being set up.
Design the operating model for a multi-state provider network: launch, credentialing, revenue cycle and provider support
Turn proprietary platform data into the KPIs that run the company and anchor our board reporting
Shape what we automate next, alongside an engineering team that ships every week
Lead a lean, distributed operations team and a bench of specialist partners
This is a leadership seat with real decision rights, scoped for a fractional schedule.
What you'll own
You own how operations runs end to end: the cadence, the metrics, the processes, and the partners. You set the system; your team and partners execute inside it.
Key Responsibilities
Operating Cadence & Reporting
Own the weekly operating review, KPI definitions, and the scorecard used by founders, board members, and investors.
Outcome: One trusted set of numbers behind every weekly decision.
Revenue Cycle
Oversee revenue cycle performance across billing partners and our RCM platform, including claim throughput, denials, accounts receivable (A/R), and collections.
Outcome: Best-in-class collections and cash velocity as volume scales.
Credentialing & Payer Enrollment
Manage the credentialing pipeline, payer status, enrollment records, and expiration dates across every state we serve.
Outcome: Faster time to in-network status with every new state and payer.
Practice Launch Engine
Own the contract-to-first-patient playbook, including its gates and service-level agreements (SLAs).
Outcome: Industry-leading launch speed, measured and improving every month.
Provider & Patient Operations
Own the support model for nurse practitioners (NPs) and the front desk, including routing, SLAs, and quality standards.
Outcome: A provider experience NPs recommend to their colleagues.
Partners
Own SLAs, scorecards, and commercial terms for our specialist partners.
Outcome: Every partner measured, accountable, and scaling with us.
People & Systems
Lead the operations team, manage the SOP library, and establish automation priorities with engineering.
Outcome: An operation that scales ahead of growth.
Who you are
You've built and scaled operations at a healthcare services company, and you can lead at that level in 15 focused hours a week.
Must have
15+ years in operations, with 5+ in a senior role (COO, VP Operations, Head of Operations) at a healthcare services company: MSO, physician or NP group, multi-site practice, or tech-enabled provider
Deep command of the revenue cycle: claims, denials, A/R, payer enrollment and credentialing. You know what best-in-class looks like and how to get there
A record of scaling a repeatable, multi-location launch or onboarding process
Experience leading distributed teams and specialist partners through clear SLAs and scorecards
You build the reporting yourself: you define the metrics, find the data and make it a weekly habit
Systems thinking with a bias to action. You write the SOP, then delegate it, then automate it with engineering
You thrive at a fast-growing company: you move quickly, decide with judgment and build what doesn't exist yet
Strong plus
Fractional or interim COO experience with high-growth startups
PC-MSO structure and multi-state healthcare compliance, including HIPAA
Medicaid managed care and Medicare enrollment experience in the Northeast or Mid-Atlantic
Has led an EHR or RCM platform rollout
Has worked alongside an engineering team to turn operational workflows into product
How we'll work together
You'll run operations as a leader with real authority, on a cadence built for 15 hours a week.
Weekly: you run the ops review with the founders and own its scorecard; you hold the standing calls with our billing and credentialing partners
Monthly: you deliver an operations report covering launches, credentialing, revenue cycle and provider productivity, with a short list of decisions you need from us
Async by default: Slack, Notion and our internal tools; you decide what needs a meeting
Decision rights: you set process, priorities and SLAs for operations and the people and partners who execute them
What this role is not
Not an executor. Your operations team and partners own the day-to-day work; you design the system they work in and hold it to a standard.
Not engineering. Our engineering team owns the platform and integrations. You own the requirements, the data definitions and the priority of what to automate.
Not clinical. Our medical and clinical director owns clinical and compliance oversight; you make sure the operations around it run cleanly.