Chief Operating Officer

Job Description

Job Description

Organizational Summary

Contraceptive care is basic healthcare. Yet too many patients in the U.S. struggle to access the care they need, when they need it. Founded in 2014, Upstream USA is a national, nonpartisan nonprofit dedicated to ensuring that equitable, patient-centered contraceptive care is available to everyone.

Our Mission and Impact

Upstream works to ensure individuals can make fully informed, autonomous decisions about the contraceptive methods that are best for them. We are currently the largest contraceptive organization in the country improving contraceptive care in primary care settings, operating in 37 states and Washington, D.C.

While our foundational work focuses on partnering with healthcare organizations offering primary care, such as federally qualified healthcare centers (FQHC) and health systems, we are always evolving. We are actively pursuing additional, innovative paths to ensure every patient has streamlined access to the contraceptive service of their choice, where and when it is most convenient for them.

A Different Kind of Nonprofit

Upstream is a venture philanthropy-backed nonprofit with a current annual budget of $50M+. Operating in a dynamic external landscape, Upstream maintains a high-performance culture anchored in actionable, observable behaviors. It keeps its patient-centered mission at the core of every decision, continually adapting and embracing change to meet evolving patient needs. Its culture prioritizes resilience, strategic nimbleness, and a focus on measurable outcomes over effort—ensuring it remains responsive, accountable, and capable of driving long-term impact at scale.

Recognition: We are a 2023 Audacious Project recipient, with our work featured in publications like Harvard Public Health , Bloomberg , and MedPage Today .

We welcome individuals who are driven by impact and scale to join us in making equitable contraceptive access a reality for all.

This search is being managed exclusively by our executive search partner, Egon Zehnder. To be considered for the opportunity, please email your resume and cover letter to View email address on us.fitly.work, with "Upstream COO" in the subject line. Please do not apply on Upstream's career site.

The Chief Operating Officer (COO) will serve as a member of Upstream's senior leadership team, reporting into the CEO, and will lead the execution of the organization's strategy to rapidly scale its growth, effectiveness and impact. Beyond operational excellence, this role is fundamentally about driving and enabling ambitious, large-scale impact nationwide. At a time of rapid change and ambiguity in the highly complex and fluid birth control marketplace, the COO will own all current and future Upstream programs to enable as many patients as possible to make fully informed, autonomous decisions about the contraceptive methods that are best for them .

To drive pace and change, the Upstream COO will play a key role in helping shape the future trajectory of a nationally recognized, fast-growth, mission-driven organization. This presents a unique opportunity for an experienced builder and operator who loves driving results across multiple teams, is comfortable with final decision-making authority in a collaborative environment and is excited about leading efforts in a fast-changing environment where innovation is the norm, new products are coming online, and pivots are essential.

Essential Duties and Responsibilities

• Own programs end-to-end: Own Upstream's current and future programs, including to launch, scale, learn, adapt, and drive towards continued growth. Launch: Partner with the Vice President of Strategy and Innovation to take new, tested innovations to scale. Rapidly understand what works and what doesn't work. Prioritize and invest in those with highest potential. Grow: Lead and execute marketing and sales of existing, core programs (e.g., training and technical assistance) as well as new, innovative programs as they come online (e.g., FreeBC and other future digital and direct-to-consumer approaches).
• Measure: Truly understand the impact of Upstream's programs through existing and new measurement approaches. Set clear expectations for program growth and impact.
• Adapt : Actively adjust programs based on measurement and other performance indicators to ensure continuous improvement and hyper-focus on growth, scale, and adaptability to changes in an already complex marketplace.
• Ensure operational effectiveness: Manage finances for all operating activities. Assess the operational needs of the organization and address gaps. Contribute to Board related processes and materials.
• Drive culture and behaviors: Consistent with Upstream values, foster a mission-centered culture that embraces change and growth in which team members rapidly drive towards clearly defined outcomes based on data, active listening, and constructive challenge. Role-model core organizational traits of integrity, trust, reliability, respect for diverse perspectives, resilience, and fun.

Role Location and Travel

While location is flexible, this role will require up to 20% business travel. This leader can expect to travel once or twice per month for multiple days. Travel will include visits with partner healthcare organizations, leadership meetings, regional operational gatherings, team retreats and organization-wide gatherings.

Leadership Competencies

• Delivering Results: The ideal leader drives outcomes by consistently delivering against stretch targets and commitments, overcoming obstacles and challenges as necessary. The COO is comfortable and effective in making decisions and can engage direct reports and the broader organization in building a culture of accountability for results. They are diligent in performance management and follow-up, having a natural orientation towards monitoring milestones, KPIs,and tracking performance.
• Grounding in Strategy: The ideal leader has strong analytical capabilities and an agile mind, able to identify and prioritize key operational drivers of success and performance, aligning execution with strategy. The COO can articulate a market-facing plan with an effective set of priorities to drive action, with well-defined metrics and milestones. They brings strong strategic orientation toward customers and market dynamics and identifies opportunities to align and improve programs with overarching strategic priorities.
• Influencing Collaboratively: The ideal leader has demonstrated capabilities as an effective collaborator who builds and maintains effective relationships with a wide range of diverse, internal and external stakeholders. The COO readily builds trust and respect, is seen as being able to create productive team dynamics, and is known as someone who others seek out to get opinions or perspectives. They are effective at driving alignment around decisions and priorities and can be an effective negotiator and facilitator when required.
• Leading Teams: The ideal leader is effective at developing and managing high-performance teams. The COO builds engagement by expecting and motivating team members to contribute and take full ownership for their responsibilities and targets. They are an effective coach who inspires appropriate action, is motivated, and stimulates talents to grow and develop. They can align others around a vision, strategic direction, and priorities, and has a balanced ability to chart the course by themselves and by inviting input from the broader team.

Hiring Range

$325,000—$350,000 USD

Pay Transparency

Final offers for this position will be based upon several factors including the scope of the role, market compensation analysis, position requirements, candidate's experience level and capabilities, fairness in internal pay considerations and will be made within the parameters of Upstream USA's compensation framework and philosophy.

Other Upstream Staff Expectations

• All Upstreamers must be able to attend work-related in-person meetings and functions as needed. 
• In our hybrid work environments, there is a basic expectation that our Upstreamers will ensure that their work from home setups will have reliable access to phone and Internet to ensure connectivity to their teams.
• At Upstream we gather for moments that matter for training, teaming and connection. Our teams come together for occasional in person meetings and organizational retreats. As part of our hybrid work practices, this travel expectation will be applicable for all Upstreamers, even those based remotely.
• Engage in organization-sponsored learning & development

Upstream Benefits

Upstream USA offers a comprehensive benefit package including medical, dental, vision, life insurance, long and short term disability, 401K with a match, generous vacation, personal, sick and holiday time off, parental leave, professional development, a fitness and cell phone allowance for all full time employees and part time employees who work a minimum of 24 hours per week. Intern positions and contingent worker roles are not eligible for benefits.

Hiring Process

Candidates who advance in our preliminary review process will have an opportunity to discuss the position, their employment background and lived experience with a member of our talent acquisition team by telephone. Those who advance to subsequent steps in our interview process may participate in up to three rounds of meetings by Zoom or in person and in a thought exercise/case study assignment. Each round could consist of multiple meetings with various Upstreamers. If you need anything in advance of your interviews, please reach out to your recruiter. 

Our Culture 

We are dedicated to fostering a fair and accessible talent lifecycle, ensuring that every individual has the opportunity to thrive. From recruitment to career development, we strive to create a workplace where talent is recognized, supported, and empowered to contribute meaningfully. Building a strong, representative workforce is essential to our success, and we prioritize collaboration, transparency, and shared leadership to cultivate an environment where all voices are heard and valued.

Our commitment extends beyond hiring—we invest in professional growth, mentorship, and inclusive workplace practices to support long-term success for our employees. You can learn more about our organization on our career site. 

Upstream Careers

Our goal is to attract, develop and retain exceptional people, and to create a work environment that is dynamic, rewarding and enables each of us to realize our potential. Upstream is committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, genetic information, gender identity or Veteran status. We also consider qualified applicants regardless of criminal histories, consistent with legal requirements. If you have a disability or special need that requires accommodation, please let us know. Upstream USA participates in E-Verify.

Upstream Headquarters

2 Oliver Street, Suite 402, Boston, MA 02109

No phone calls please.

Be advised that we do not ever conduct hiring interviews via text or email. Please protect yourself by learning more about our hiring practices and common red flags to look out for.