Fractional COO / Vice President of Operations

Why This Role Exists

Neura has grown fast on the strength of its clinical product and partnerships. But the operational infrastructure hasn’t kept pace. Here’s what’s real:

• No centralized patient contact center. We’re scaling the national practice but response SLAs aren’t being met. How might we build a system that better gets ahead of demand spikes?
• Patient messaging is fragmented. Inbound and outbound chats and messages from patients aren’t being triaged or answered with the speed and consistency a national practice demands.
• Clinical operations need tightening. Licensing and credentialing timelines are too long, which delays time-to-value for new providers. Scheduling templates haven’t been optimized to maximize clinician utilization against patient demand. We should be seeing every patient within 7 days — and then pushing that number lower.
• B2B implementation and customer success need a playbook for driving predictable visit volume. We’re onboarding health system partners, but the go-live process and ongoing account operations aren’t standardized. That limits expansion and referenceability.
• Operational bloat from process and system inefficiencies. We know it’s there. Some of it is actively being worked out. We need someone who can accelerate the cleanup, assess our current tools (including our CRM, Kustomer), and make fast calls on what to fix, what to replace, and what to automate.
• The CEO is the integration point for too much. Initiatives, KPIs, and cross-functional projects lack centralized ownership and tracking. That doesn’t scale.

We’re hiring a fractional COO to own all of this. You’ll report directly to the CEO and free them to focus on business development — while you run the full patient-facing, clinical, and B2B operational stacks.

What You’ll Do in the First 30 Days

This is triage. You’ll assess the current state, make fast decisions, and start building.

• Stand up the call center. Establish a centralized patient contact operation with a national 1-800 number. Define the scope: inbound (clinical questions, tech support, customer service) and outbound (patient activation). Set initial SLAs, staff or contract the team, and get it live.
• Get control of patient messaging. Audit the current state of inbound and outbound patient chats and messages. Implement triage workflows and response time standards so patients get timely, consistent answers. Build a playbook for proactive staffing.
• Audit clinical scheduling templates. Review how clinician time is currently allocated and identify where scheduling templates are leaving capacity on the table. Begin restructuring to maximize patient access and provider utilization.
• Assess licensing and credentialing pipelines. Map the current process end-to-end. Identify where delays are happening and implement changes to compress time-to-value for new providers.
• Evaluate the CRM. Conduct a rapid assessment of Kustomer — what’s working, what’s not, and whether we can unlock more efficiency from the current platform or need to plan for a migration.
• Establish the operating cadence. Implement daily and weekly rhythms: standups, KPI reviews, cross-functional syncs, and escalation paths. Replace ad-hoc coordination with structure. Build a framework to predictably hit visit volume goals while maintaining high NPS, CSAT, and SLAs.
• Build the dashboards. Define and stand up the operational KPIs that matter — visit volume, provider utilization, time-to-appointment, conversion rates, patient NPS, and response SLAs. Make them visible daily.

The bar: The call center is operational. Patient messaging has clear SLAs and triage. Scheduling templates have been restructured. Leadership has daily visibility into operational performance. Patients and partners are already feeling the difference. You’ve made more decisions in a month than most operators make in a quarter.

What You’ll Do by Day 60

The foundation is in place. Now you’re optimizing, scaling, and starting to build the next layer.

• Hit the 7-day SLA. Every patient sees a provider within 7 days. Once achieved, begin driving that number lower.
• Streamline B2B implementation. Build a repeatable playbook for onboarding health system partners — from go-live implementation (where Neura operates as an extension of the health system’s neurology practice) through ongoing customer success operations. The goal: faster launches, smoother expansions, and partners who become references.
• Partner with marketing on top-of-funnel conversion. Work cross-functionally to improve patient conversion at the top of the funnel. Operations and marketing alignment is a growth lever — own your side of it.
• Begin the AI automation roadmap. With the call center foundation stable and scalable, identify where off-the-shelf AI partners can handle a significant portion of inbound and outbound calling — reducing FTE needs and improving the cost structure. Prescription refills are another high-volume, high-time-burn category that’s a clear candidate for AI handoff once the process is standardized.
• Attack COGS and OpEx. With operational data flowing and processes stabilized, identify the clearest opportunities to reduce cost of goods sold and operating expenses. This includes automation, vendor consolidation, process elimination, and staffing model optimization.
• Deliver a CRM recommendation. Based on your 30-day assessment, present a clear recommendation: optimize Kustomer or plan a migration. Include timeline, cost, and operational impact.
• Uplevel the team. By now you’ve coached, restructured, or made changes where needed across your four direct reports. The operations org should be operating with clear ownership, consistent execution, and measurably higher output.

The bar: The 7-day SLA is being met. B2B has a playbook. The AI automation plan is scoped. COGS and OpEx improvement targets are identified with clear paths to hit them. The operational engine is running — not because you’re pushing it, but because the systems and team are working.

What You’ll Own Long-Term

Patient Contact Operations (Call Center + Messaging)

The full inbound and outbound patient communication stack — 1-800 line, chat/messaging, clinical questions, tech support, CS, and outbound activation. You own the SLAs, the staffing model, and the roadmap to automate what should be automated.

Clinical Operations

Provider scheduling, utilization, licensing, credentialing, and the operational infrastructure that determines how fast patients get seen. You own time-to-appointment and the levers that move it.

B2B Operations

Implementation playbooks, go-live execution, and customer success operations for health system partnerships. You own partner satisfaction, expansion velocity, and referenceability.

Operational Efficiency and Cost Structure

Process optimization, system rationalization (including CRM), AI automation strategy, and the ongoing work of reducing COGS and OpEx without compromising patient or provider experience.

The Team

Four direct reports spanning D2C operations, B2B operations, provider recruiting, and payor contracting. Set clear expectations, build development plans, and make honest assessments about where the team needs to level up.

The Scoreboard

Patient NPS. Time to appointment. Provider utilization. Visit volume targets. Call center SLAs. B2B go-live timelines. On-time state launches. These aren’t aspirational — they’re your accountability.

What We’re Looking For

Required

• 10+ years in healthcare operations, including leadership roles (VP/Director of Ops, Head of Clinical Operations, or equivalent) in a multi-state or rapidly scaling organization.
• Experience standing up and running patient contact center operations — inbound, outbound, multi-channel. You’ve built this before, not just managed it.
• Direct experience building operational infrastructure from scratch or early stage — you’ve gone from “no system” to “the system runs itself” at least once, and you did it fast.
• Deep knowledge of provider licensing, credentialing, and multi-state healthcare expansion. You know the regulatory landscape and have compressed timelines that others said couldn’t move.
• Experience optimizing clinical scheduling and provider utilization to maximize patient access and clinician productivity.
• Demonstrated ability to build and run KPI dashboards, operating cadences, and project management frameworks that changed how a team executed — not just how it reported.
• Experience managing cross-functional teams spanning clinical, regulatory, product, growth, and marketing functions.
• Comfort operating as both architect and operator. You’ll design the systems AND work inside them — pulling data, chasing down blockers, and getting into the details when something isn’t tracking.
• The ability to drive accountability without positional authority alone. You’ll need to influence senior leaders and hold people to commitments in a fast-moving, sometimes messy environment.

Strongly Preferred

• Experience in telehealth, digital health, or tech-enabled care delivery — you understand the unique operational dynamics of virtual clinical models.
• Background in fractional or consulting leadership roles where you’ve had to move fast, build trust quickly, and deliver measurable results within a defined scope.
• Experience with AI-enabled operations tools — you’ve evaluated or deployed AI solutions for patient communication, call handling, or clinical workflow automation.
• Experience with CRM evaluation and migration in a healthcare or high-volume patient communication environment.
• Experience building B2B implementation playbooks and customer success operations for health system or enterprise partnerships.
• Experience building performance management systems tied to revenue or growth outcomes, not just operational efficiency.

Who This Is For

You love hard problems. Not in an abstract, intellectual way — you love walking into a room where nothing works the way it should and walking out with it fixed. You’ve done things in 30 days that other operators take 6 months to attempt. You know this about yourself because you’ve done it repeatedly and have the results to prove it.

You are no-bullshit. You don’t over-analyze when the answer is obvious. You don’t build consensus when a decision needs to be made now. You make fast calls, own the outcomes, and course-correct in real time. You’d rather be 80% right today than 100% right in three weeks. You’d rather ship a working solution that delights a patient or a client than spend another week perfecting a process document no one reads.

You can achieve what many others can’t in a short period — not because you work more hours, but because you see the critical path immediately, ignore the noise, and execute with a precision that compounds. You’ve been the person that CEOs hand the hardest operational problems to because you’re the one who actually solves them.

This is not a “steady-state operations” role. Neura is building the plane while flying it, and the operational foundations are genuinely early. If you need polished systems to inherit, this isn’t the right fit. If you need perfect information before you act, this isn’t the right fit.

You’ll do well if messy, high-stakes operational problems give you energy. If you naturally create order from chaos. If you measure your own success by whether patients and clients are delighted — not by whether the documentation is comprehensive or the dashboard is pretty. The team is small, committed, and moves fast. They’ll respect you for what you build, not for your title.

Compensation

Fractional engagement, scoped at 15–25 hours/week. Compensation commensurate with experience and engagement scope. Discuss details directly with our CEO.

Logistics

This is a remote role. If you’re within commuting distance of our NYC office (205 East 42nd Street), we’d ask you to be in-office two days a week (Tuesdays and Thursdays) — the rest of the team follows the same hybrid rhythm.