Manager, Member & Provider Services

Independent Living Systems, llc; Los Angeles (CA); On-site; USD 72,000 - 125,000; Full time

Job summary

Independent Living Systems (ILS) in Los Angeles, CA is hiring a Manager, Member & Provider Services to oversee the contact center that supports members and providers in healthcare and social assistance. You will lead a team, drive performance through metrics, and ensure service quality and regulatory compliance.

The role emphasizes First Call Resolution, mentorship, and collaboration with clients and cross-functional teams to deliver exceptional service and outcomes.

Qualifications

• Bachelor’s degree in Healthcare Administration, Business, or related field.
• 5+ years of member or provider services in healthcare or social assistance; at least 2 years in a supervisory role.
• Experience with Medi-Cal eligibility and benefits.
• Experience using operational metrics, reports and quality audits to drive performance improvements.
• Strong organizational, analytical and time-management skills.
• 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; manage multiple projects.

Responsibilities

• Lead daily operations of the Contact Center, ensuring timely resolution and First Call Resolution (FCR).
• Recruit, train, and develop staff; conduct regular departmental meetings to communicate updates.
• Supervise, coach, mentor, and evaluate team members against productivity and quality standards.
• Oversee investigation and resolution of complex member/provider cases with guidance on compliance.
• Monitor regulatory turnaround times, SLAs, and performance metrics to ensure customer satisfaction.
• Develop, implement and maintain QA programs, procedures, workflows, and training materials.
• Collaborate with internal and external partners to resolve issues and improve service delivery.
• Ensure adherence to HIPAA and other regulations; participate in audits and reporting.

Skills

Communication

Organizational skills

Analytical skills

Time management

PHI handling

Regulatory compliance

Leadership

Customer service

Education

Bachelor’s degree in Healthcare Administration

Master’s degree in Healthcare Administration

Tools

CRM software

Electronic Health Records (EHR)

Job description

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Manager, Member & Provider Services

California Care Management Programs Full Time Management Los Angeles, CA, US

2 days ago Requisition ID: 3391

Salary Range: $72,009.60 To $125,008.00 Annually

We are seeking a Manager, Member & Provider Servicesto join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations

About the Role:

The Manager, Member & Provider Services plays a vital role in overseeing the daily operations of the contact center dedicated to supporting members and providers within the healthcare and social assistance sector. The Manager, Member & Provider Services is responsible for ensuring that all member and provider inquiries, concerns, and support requests are handled efficiently, accurately, and with empathy, thereby enhancing overall satisfaction and retention. The Manager, Member & Provider Services will lead, mentor, and develop a team of member and provider services representatives, fostering a culture of continuous improvement and high performance. The Manager, Member & Provider Services works collaboratively with health plan clients, providers, internal operational teams, and compliance partners to ensure exceptional service delivery, regulatory compliance, quality outcomes, and operational efficiency. Additionally, the Manager, Member & Provider Services collaborates with cross-functional teams to implement process improvements, monitor key performance indicators, and ensure compliance with regulatory requirements. Ultimately, the Manager, Member & Provider Services will drive operational excellence to support the organization's mission of delivering exceptional services and support.

Minimum Qualifications:

• 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 required.
• 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.

Preferred Qualifications:

• Master’s degree in Healthcare Administration, Public Health, or Business Administration.
• Experience with healthcare information systems and customer relationship management (CRM) software.
• Experience in care management, Enhanced Care Management (ECM), Community Supports, housing navigation, or related healthcare service delivery programs.
• Experience with electronic health record (EHR) systems.

Responsibilities:

• Demonstrates commitment to Our Mission and models ILS Experience Standards of Excellence.
• 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 the investigation 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, operational 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.

Attend scheduled meetings, trainings, leadership forums, and cross-functional workgroups.