Job Description

28 million Americans with Medicaid need mental health care. Only a third of them will find it.

The math is devastating. Millions of America’s most vulnerable population are left waiting – not weeks, but months – without access to the mental health treatment they desperately need. Systemic barriers like operational complexity discourage practices from accepting Medicaid patients at all, and low reimbursement rates make them financially unattractive to most providers. This keeps care out of reach for those who need it most.

When Medicaid patients can’t find care, their treatable conditions escalate into crises. Emergency rooms become their only option. Lives that could have been transformed through early intervention instead spiral downward. This is a solvable problem.

This is where Third Space comes in.

We’re a virtual outpatient behavioral health practice built specifically for Medicaid patients. We’re on a mission to bridge this gap and rapidly increase access to care for underserved patients.

We accept most Medicaid and some commercial insurance plans. For patients, this means quality virtual therapy at no cost or very low cost – often as soon as 48 hours after reaching out.

We’ve proven there is enormous demand. Now we’re building the engine that allows us to serve that demand across states, payers, providers, and clinical services without sacrificing quality.

The numbers speak for themselves

• 17 million lives covered across Medicaid and commercial plans
• 8x revenue growth in 2025
• 5 days median time to first appointment (vs. 3–6 months industry standard)
• 81% of Medicaid patients return for a second appointment
• ~60% of patients see measurable improvement in depression (PHQ-9) and anxiety (GAD-7) scores

We're not a stopgap. We're building what mental health care access in America should have always looked like.

Why work at Third Space

• You'll move the needle on something that matters. Your work will directly touch millions of lives during, arguably, the most consequential moment for Medicaid in recent history.
• You’ll solve problems that actually constrain access to care. Credentialing delays, payer complexity, broken workflows, and operational bottlenecks directly determine whether patients can get treated, and how soon they get into care after reaching out.
• Strong PMF, scaling fast. Revenue grew 8x in 2025. We've proven the model and built the engine. Now we ned to make the operating system substantially more scalable.
• Direct access and real ownership. You will work side-by-side with the founders and have genuine influence over how Third Space grows, while working with government and private stakeholders. You'll own P&L for some of the most important systems in the company.
• You'll be building something that hasn’t existed before. Many of the processes you’ll ultimately manage still need to be designed, documented, automated, or rebuilt.
• Humans + AI agents. Third Space is deploying AI agents across our operations. You won't just use AI tools; you'll help shape how an agentic care delivery company actually works in practice. You should be excited about figuring out what humans should own, what software should own, and how the two work together.
• Backed by people who've done it before. Our investors include the former Chief Medical Officer of the US Medicaid program, founders of companies like Thirty Madison, Tennr, Jimini Health, Brellium, Altitude, Tilly Therapy, and investors in companies like Calm, Grow Therapy, BetterUp, Midi Health, and others.

Third Space is backed by Zeal Capital Partners, Actions Capital (fka K50 Ventures), RiverPark Ventures, Evio VC, and Pareto Holdings.

Join us at Third Space and help reimagine what’s possible for mental healthcare access in America – Come build America’s home page for Medicaid alongside us.

If you want to solve one of the most pressing challenges facing the country today, we want to hear from you.

About the Role

Almost every operational function at Third Space currently routes through our COO.

That worked when we were active in a handful of states. It won’t work when we triple our geographic footprint.

We’re hiring a Director of Operations to take ownership of the operational engine behind Third Space: credentialing and payer enrollment, revenue cycle, provider operations, new-state launches, compliance infrastructure, systems, vendors, and the team that keeps those functions moving.

This is not a role where you design the process and hand off the execution to someone else.

You’ll manage people, but you’ll also get into the details yourself. You should be comfortable opening a Medicaid portal to understand why an enrollment is stuck, digging through a denial report, figuring out why a workflow keeps failing, writing the SOP, and then redesigning the system so the problem doesn’t happen again.

We’re looking for someone who can move fluidly between:

• Operating: solving the problem in front of you
• Managing: creating accountability across a team and external partners
• Building: turning repeated work into systems
• Planning: seeing operational constraints before they become company constraints

You won’t be handed a finished playbook. You’ll help write it.

This is a hybrid position. Some travel may be required (~10%).

This role reports directly to the COO.

Read more about how we work: The Room We’re Building | Our Values

What You’ll Work On

Credentialing & Payer Operations

• Own the operational lifecycle required to get clinicians credentialed, enrolled, and ready to serve patients.
• You’ll manage the credentialing function, establish clear turnaround targets, maintain a reliable view of every application and payer, and personally unblock difficult cases when needed.
• You’ll continuously improve the systems behind CAQH, PECOS, state Medicaid enrollment, MCO enrollment, roster management, revalidations, and payer administration.
• The goal isn’t just to process applications. It’s to make credentialing predictable enough that the rest of the company can plan around it.

New-State Launches

• Own the operational playbook for launching Third Space into new markets.
• You’ll coordinate payer enrollment and contracting, regulatory and operational requirements, provider readiness, billing configuration, systems setup, and launch dependencies across teams.
• Every state we launch should make the next one faster.
• You’ll turn what we learn into a documented, repeatable operating system.

Provider Operations

• Own the operational systems that support our clinical workforce from onboarding through ongoing operations.
• That includes onboarding and offboarding workflows, compensation and payment operations, HRIS administration, operational issue resolution, provider data integrity, and coordination across credentialing, billing, recruiting, and clinical leadership.
• You’ll also help build the capacity model that connects patient demand with provider supply and gives recruiting a clear view of where we need additional clinical capacity.

Revenue Cycle

• Own the operating relationship between Third Space, our billing partners, our payers, and our internal systems.
• You should be able to look at an aging report or denial trend and understand where money is getting stuck.
• You’ll hold partners to defined service levels, ensure billing configuration stays accurate, identify recurring failure modes, and drive improvements across clean claims, denials, collections, and A/R.
• You don’t need to personally submit every claim. You do need to understand the system well enough to know when it isn’t working.

Compliance & Operational Readiness

• Build the operational infrastructure that keeps a multi-state healthcare company audit-ready.
• Own recurring compliance workflows including credential maintenance, exclusion screening, revalidations, attestations, provider records, and other operational requirements.
• Partner with clinical leadership when specialist interpretation is required, while owning the operational process that turns requirements into something the company reliably executes.

Systems, SOPs & Automation

• Build the operational knowledge base of the company.
• Repeated work should become documented work. Documented work should become standardized work. Standardized work should become automated wherever it makes sense.
• You’ll create SOPs that another team member can actually execute, establish clear owners and service levels, and work closely with the COO to identify opportunities for AI agents and automation.
• You do not need to be an engineer.
• You do need to be good enough at systems thinking to explain exactly how a workflow should work.

Team & Vendor Management

• Manage and develop the people responsible for core back-office operations.
• Set expectations, establish metrics, review work quality, identify bottlenecks, and create accountability without requiring leadership to intervene.
• You’ll also own key operational vendors and outsourced partners, including performance, service levels, renewals, and cost.
• As we add offshore or outsourced capacity, you’ll determine which work should move, how it should be documented, how quality should be measured, and what controls need to exist around access and PHI.

Operating Planning & Reporting

• Own a single source of truth for the health of the operation.
• Leadership should not need five Slack threads and three spreadsheets to understand where something stands.
• You’ll build the weekly operating cadence covering credentialing, provider capacity, revenue cycle, market launches, compliance, staffing, and major risks.
• You’ll also own the operating budget for your function and continuously improve the amount of operational output we get from each dollar and each team member.

What We’re Looking For

Required

• 3+ years of healthcare operations experience, including meaningful people-management responsibility
• Direct, hands-on experience with credentialing and payer enrollment across multiple states
• Strong familiarity with Medicaid and managed care
• Revenue cycle fluency: you can read an aging report, diagnose denial patterns, understand the drivers of collections, and hold a billing partner accountable
• Experience building and improving operational workflows across multiple teams or systems
• Comfortable researching and operationalizing state or payer requirements rather than waiting for someone else to interpret them
• A track record of writing SOPs and building processes people actually use
• Strong spreadsheet and operational-data fluency
• Comfortable becoming a power user of unfamiliar systems quickly
• Experience managing vendors, outsourced teams, or offshore operations
• Experience operating in a startup or similarly ambiguous environment where the process often did not exist before you arrived
• Clear, direct written communication
• High attention to detail without losing sight of what matters most

Strongly preferred

• Behavioral health experience
• Experience with multi-state healthcare delivery
• Familiarity with MSO–PC structures and professional entity requirements
• Experience launching healthcare operations in new states
• Experience renegotiating or operationalizing payer agreements
• Experience implementing or migrating an EHR, credentialing system, HRIS, or revenue-cycle workflow
• Evidence that you actively use AI and automation to make yourself and your team more effective

You do not need to have encountered every problem we will face.

You do need to be the kind of person who figures things out, builds a point of view, takes ownership of the outcome, and makes the system better after solving the immediate problem.

Who You Are

We have six values at Third Space. They’re not aspirational; they’re how we expect our teammates to operate. Read the full version here.

• Integrity. You tell us what’s actually happening, including when the answer is uncomfortable. The work you do at 4pm on a Friday is the same quality as the work you do Tuesday morning. You tell the truth in a difficult meeting. You don't optimize for how things look; you optimize for what's real. In a company serving vulnerable people, this is the floor, not the ceiling.
• Ownership. You own outcomes, not tasks. Problems do not disappear because they technically belong to someone else. When something goes wrong, you raise your hand first. When something goes well, you document what worked so the team can repeat it. There are no gaps someone else will fill.
• Agency. You don't wait for a brief. You work out what's next, roll up your sleeves, and start building. You investigate before escalating. When you raise a problem, you usually bring a recommendation with it. We hire people who make the surface area of this company larger, not smaller.
• Compassion. Operational decisions ultimately affect patients and clinicians. Efficiency never becomes an excuse to forget that. The patients we serve are navigating some of the hardest moments of their lives. That context doesn't disappear when you're writing a cold email or building a dashboard. Every decision this company makes touches a human being – act accordingly.
• Craft. Details matter. A clean tracker, accurate report, thoughtful SOP, and well-designed handoff are part of doing excellent work. The quality of your work is not determined by who's watching or how visible the task is. A well-written cold email matters. A clean handoff matters. How you do anything is how you do everything.
• 0–0. Success doesn’t make us complacent and setbacks don’t make us spiral. We deal with the problem in front of us and keep moving. The score is always nil-nil. No one is winning; no one is losing. We bring the same present-focus to everything: a strong quarter doesn’t mean we ease up, and a hard week doesn’t mean the mission is broken.

What Success Looks Like

You’ll be measured on outcomes, not activity.

Key metrics will include:

• Median days from clinician readiness to first payer approval and full target-payer enrollment
• Percentage of required payer enrollments completed ahead of planned market or provider go-live
• Credentialing backlog, aging, and turnaround-time SLA attainment
• Clean claim rate and first-pass yield
• Denial rate and recurring denial drivers
• Days in A/R and A/R aging
• Net collection rate
• Accuracy and timeliness of provider compensation operations
• On-time completion of compliance activities, revalidations, attestations, and screenings
• New-state launches completed against operational readiness milestones
• SOP coverage and process adherence across core operational workflows
• Vendor SLA performance and cost efficiency
• Operating leverage — scale clinical volume and operational complexity without proportional growth in operations headcount or spend, while maintaining high standards for service levels, accuracy, and compliance

Compensation & Benefits

Compensation

• Base Salary: $160,000–$180,000 annually based on experience
• Performance Incentives: 10% of base, tied to defined operational outcomes
• Equity: Meaningful equity in addition to the base salary, with standard vesting

Benefits Package

• Comprehensive health, dental, and vision insurance
• Unlimited PTO + paid public holidays
• 401(k) with employer match

If you want to help build the operational infrastructure for an agentic care delivery company, that allows millions of Medicaid patients across America to access care, during the most consequential time for Medicaid in recent history, we want to hear from you.