Healthcare Member & Provider Services Manager

Independent Living Systems; San Diego (CA); Presencial; USD 72.000 - 125.000; Jornada completa

Descripción de la vacante

Independent Living Systems in San Diego, CA seeks a Manager, Member & Provider Services to oversee the Contact Center operations supporting members and providers in healthcare and social assistance. You will recruit, train, and mentor staff, drive performance with metrics, ensure HIPAA and regulatory compliance, and collaborate with health plan clients to deliver high-quality service.

This is a full-time role requiring a Bachelor’s degree and 5+ years of relevant experience, including 2+ years

Formación

• Bachelor’s degree in Healthcare Administration, Business, or a related field.
• Minimum of 5 years of member or provider services in the healthcare or social assistance industry, 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 effectively manage multiple priorities and deadlines.
• Excellent communication, organizational, and interpersonal skills.
• Ability to maintain confidentiality and handle protected health information (PHI) in accordance with HIPAA regulations.
• Ability to work independently and as part of a team to balance competing priorities and manage multiple projects simultaneously.
• Ability to work flexible hours as needed to support operational requirements.

Responsabilidades

• Lead and manage the daily operations of the Contact Center, ensuring timely and effective resolution of all inquiries and issues leading to First Call Resolution (FCR).
• Recruit, train, and develop contact center staff to maintain high standards of customer service and operational efficiency; keep staff informed of updates through regular departmental meetings.
• Supervise, coach, mentor, and evaluate team members, establishing and monitoring productivity, quality, timeliness, customer service, and professional development standards to achieve departmental objectives.
• Oversee investigations and resolution of complex and escalated member and provider cases, providing guidance to staff and ensuring compliance with contractual, regulatory, organizational, and client-specific requirements.
• Monitor regulatory turnaround times, service level agreements, and operational performance metrics to ensure timely resolution, quality outcomes, and customer satisfaction.
• Develop, implement, and maintain quality assurance programs, procedures, workflows, training materials, and performance standards to ensure accuracy, consistency, documentation integrity, and compliance across all service recovery activities.
• Collaborate with internal and external partners to resolve complex issues, improve service delivery, and support organizational objectives.
• Ensure adherence to federal and state regulations, health plan requirements, organizational policies, HIPAA standards, confidentiality requirements, and audit readiness, including participation in audits, regulatory reviews, client reporting, and quality improvement activities.

Conocimientos

Leadership

Communication

Organizational skills

Analytical skills

Time management

HIPAA compliance

Educación

Bachelor's degree in Healthcare Administration/Business

Master’s degree in Healthcare Administration/Public Health/Business

Descripción del empleo

Independent Living Systems in San Diego, CA seeks a Manager, Member & Provider Services to oversee the Contact Center operations supporting members and providers in healthcare and social assistance. You will recruit, train, and mentor staff, drive performance with metrics, ensure HIPAA and regulatory compliance, and collaborate with health plan clients to deliver high-quality service.

This is a full-time role requiring a Bachelor’s degree and 5+ years of relevant experience, including 2+ years