Head of Member & Provider Services

Independent Living Systems, llc; Riverside (CA); Presencial; USD 85 000 - 115 000; Tempo integral

Resumo da oferta

Independent Living Systems, LLC in Riverside, CA is hiring a Manager, Member & Provider Services to oversee the contact center for members and providers in healthcare. You will lead a team, ensure First Call Resolution, and collaborate with health plan clients and compliance partners to drive quality and efficiency.

The role emphasizes mentoring staff, maintaining HIPAA compliance, and using metrics to improve performance while balancing regulatory requirements and service levels.

Qualificações

• Bachelor’s degree in Healthcare Administration, Business, or a related field.
• Minimum of 5 years of member or provider services in healthcare or social assistance, with at least 2 years in a supervisory role.
• Experience with Medi-Cal eligibility and benefits.
• Demonstrated experience using operational metrics, reports, and quality audits to drive performance improvements.
• Strong organizational, analytical, and time-management skills with the ability to manage multiple priorities.
• Excellent communication, organizational, and interpersonal skills.
• Ability to maintain confidentiality and handle PHI per HIPAA regulations.
• Ability to work independently and as part of a team.

Responsabilidades

• Lead and manage the daily operations of the Contact Center, ensuring timely and effective resolution with First Call Resolution.
• Recruit, train, and develop contact center staff to maintain high standards of service and operational efficiency.
• Supervise, coach, mentor, and evaluate team members against productivity, quality, and development standards.
• Oversee investigation and resolution of complex member and provider cases, ensuring compliance.
• Monitor regulatory turnaround times, SLAs, and performance metrics to ensure quality outcomes.
• Develop, implement, and maintain QA programs, procedures, workflows, and training materials.
• Collaborate with internal and external partners to improve service delivery and compliance.
• Ensure adherence to federal/state regulations, HIPAA standards, and audit readiness.
• Attend scheduled meetings, trainings, leadership forums, and cross-functional workgroups.

Conhecimentos

Leadership

Healthcare operations

Medi-Cal experience

PHI / HIPAA

Performance metrics

Team development

Regulatory compliance

Time management

Formação académica

Bachelor's degree

Master's degree

Ferramentas

CRM software

EHR systems

Descrição da oferta de emprego

Independent Living Systems, LLC in Riverside, CA is hiring a Manager, Member & Provider Services to oversee the contact center for members and providers in healthcare. You will lead a team, ensure First Call Resolution, and collaborate with health plan clients and compliance partners to drive quality and efficiency.

The role emphasizes mentoring staff, maintaining HIPAA compliance, and using metrics to improve performance while balancing regulatory requirements and service levels.