Manager, Member & Provider Services

Independent Living Systems, llc; Modesto (CA); Presencial; USD 90.000 - 120.000; Jornada completa

Descripción de la vacante

Independent Living Systems (ILS) is seeking a Manager, Member & Provider Services to lead the contact center dedicated to supporting members and providers in healthcare and social assistance. You will mentor a team, drive performance, and collaborate across departments to ensure compliant, high-quality service delivery.

Responsibilities include overseeing daily operations, guiding process improvements, and ensuring First Call Resolution while maintaining confidentiality and HIPAA standards.

Formación

• Requires a Bachelor’s degree in Healthcare Administration, Business, or related field.
• Minimum 5 years in 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.
• Uses operational metrics, reports, and quality audits to drive performance.
• Strong organizational, analytical, and time-management skills.
• Excellent communication and interpersonal skills.
• Ability to handle PHI per HIPAA regulations.

Responsabilidades

• Oversee daily operations of the Contact Center ensuring timely resolution of inquiries.
• Hire, train, and develop staff; conduct regular meetings to share updates.
• Coach and evaluate team performance to meet productivity and quality standards.
• Manage escalation processes and ensure compliance with contractual, regulatory, and client requirements.
• Monitor service levels and key performance indicators to drive service excellence.
• Develop and maintain QA programs, procedures, and training materials.
• Collaborate with internal/external partners to improve service delivery and outcomes.
• Ensure adherence to HIPAA, confidentiality, and audit requirements.

Conocimientos

Leadership

Project management

Communication

Analytical thinking

HIPAA compliance

Multi-tasking

Team development

Educación

Bachelor’s degree in Healthcare Administration, Business, or related field

Master’s degree in Healthcare Administration, Public Health, or Business Administration (preferred)

Herramientas

CRM software

EHR systems

Regulatory reporting tools

Descripción del empleo

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.
• Performs other duties as assigned.