Director of Operations
Third Space · New York City · $160,000–$180,000 (stated in the posting)
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.
Some highlights:
In-network with 50+ Medicaid ACOs, MCOs, and commercial health plans
We cover ~17 million lives, including over 6 million Medicaid lives (nearly 1 in 10 Medicaid enrollees nationwide)
20,000+ patient sessions delivered
200+ therapy and psychiatry providers in our network
~400 organizations have referred patients to Third Space, spanning health systems, health plans, universities, safety-net clinics, and independent providers
8x revenue growth in 2025
5-day median time to first appointment compared to the usual months-long wait
81% of Medicaid patients return for a second appointment
~70% 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
The role splits into two kinds of work: ongoing ownership of functions that are already running, and scoped research projects where you make a recommendation and the exec team decides.
Ongoing Ownership
Patient Intake & Scheduling
Lead the scheduling team (offshore, already in place)
Track request volume, response time, and booking KPIs
Keep intake demand and provider capacity forecasts aligned with recruiting plans
Provider Onboarding
Own the path from signed agreement to first session: accounts, EHR setup, orientation cohorts
Build out the onboarding team as volume grows
Provider Support
Design a support model: channels, response standards, escalation paths
Set it up to scale as the network grows
Payer Relations
Build relationships with MCOs across all our states, with named contacts at each
Set clear escalation paths so issues reach the right channel
Engage in rate negotiations and manage those relationships over time
Finance
Manage the P&L – continuous monitoring to reduce bloat and improve margins
Scoped Projects
Research → recommendation → exec team decides
New State Launches
Research each target state's licensing, Medicaid enrollment, and regulatory requirements
Deliver a launch-readiness brief; the exec team makes the go/no-go call
New Service Lines
Scope requirements and economics for each new line
Share a recommendation; the exec team decides
What We’re Looking For
Required:
3+ years of healthcare operations experience, including meaningful people-management responsibility
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 at a fast-growing venture-backed startup
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.
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