Manager of Health Plan Contracting

W3Global; San Diego (CA); On-site; USD 90,000 - 130,000; Full time

Job summary

W3Global is seeking a contract negotiation and credentialing leader for its San Diego, CA operations. The role focuses on Medi-Cal, Medicare Advantage, Covered California, and other payer contracts, with emphasis on FQHC wrap-around payments and compliance.

You will coordinate credentialing/re-credentialing for physicians and other clinicians, manage provider enrollment, and align with Finance and Revenue Cycle on reimbursement and contract performance.

Qualifications

• Bachelor’s degree in Health Administration, Business, Healthcare Management, or related field, or equivalent experience.
• 3–5 years in managed care contracting and/or provider credentialing.
• At least 2 years in a California community health center, FQHC, or Medi-Cal participating safety-net.
• Strong knowledge of FQHC PPS, Medi-Cal wrap-around payments, and encounter-based billing.
• Working knowledge of California Medi-Cal managed care, DHCS policies/APLs, and CalAIM.
• Familiarity with HRSA Health Center Program requirements.
• Experience with credentialing/enrollment platforms and DHCS systems.
• Strong contract interpretation, negotiation, analytical, and financial skills.
• Excellent written and verbal communication.

Responsibilities

• Lead negotiations and renewals with Medi-Cal, Medicare Advantage, Covered California, and other payers.
• Negotiate contract terms and reimbursement rates to support FQHC operations.
• Ensure Medi-Cal contracts include appropriate FQHC wrap-around provisions.
• Monitor DHCS policies, APLs, CMS guidance, and CalAIM initiatives.
• Maintain payer contracts, rate schedules, renewal timelines, and requirements.
• Partner with Finance and Revenue Cycle to analyze reimbursement and contract performance.
• Manage payer relationships, interpretation, disputes, and issues.
• Coordinate credentialing and re-credentialing for physicians and other clinicians.
• Manage provider enrollment with Medi-Cal, Medicare, plans, and payers.
• Maintain provider enrollment records, rosters, and documentation.
• Coordinate onboarding and payer participation dates.
• Conduct required exclusion screening and maintain compliance documentation.
• Ensure contracting/credentialing meet FQHC, federal, state, and payer requirements.
• Support reporting, audits, and regulatory reviews.
• Work with leadership and multiple departments on payer and enrollment matters.

Skills

Contract negotiations

Credentialing

Analytical skills

Financial analysis

Excellent communication

Education

Bachelor's degree in Health Administration/Healthcare Management

Tools

Credentialing platforms

DHCS provider enrollment systems

Job description

Location: San Diego, CA

Job Type: Full-Time

Setting: FQHC / Community Health Center

• Lead negotiations and renewals with Medi-Cal managed care plans, Medicare Advantage plans, Covered California plans, commercial insurers, and other payers.
• Negotiate contract terms and reimbursement rates that support FQHC operations.
• Ensure Medi-Cal contracts include appropriate FQHC wrap-around payment provisions.
• Monitor DHCS policies, All Plan Letters (APLs), CMS guidance, and CalAIM initiatives affecting reimbursement and contracting.
• Maintain payer contracts, rate schedules, renewal timelines, and contractual requirements.
• Partner with Finance and Revenue Cycle teams to analyze reimbursement, revenue impact, and contract performance.
• Manage payer relationships, contract interpretation, disputes, and reimbursement issues.
• Coordinate credentialing and re-credentialing for physicians, NPs, PAs, dentists, dental hygienists, behavioral health providers, and other billable clinicians.
• Manage provider enrollment with Medi-Cal, Medicare, managed care plans, and commercial payers.
• Maintain accurate provider enrollment records, rosters, and required documentation.
• Coordinate provider onboarding and payer participation dates.
• Conduct required exclusion screening and maintain compliance documentation.

Payer Contracting & Reimbursement

• Lead negotiations and renewals with Medi-Cal managed care plans, Medicare Advantage plans, Covered California plans, commercial insurers, and other payers.
• Negotiate contract terms and reimbursement rates that support FQHC operations.
• Ensure Medi-Cal contracts include appropriate FQHC wrap-around payment provisions.
• Monitor DHCS policies, All Plan Letters (APLs), CMS guidance, and CalAIM initiatives affecting reimbursement and contracting.
• Maintain payer contracts, rate schedules, renewal timelines, and contractual requirements.
• Partner with Finance and Revenue Cycle teams to analyze reimbursement, revenue impact, and contract performance.
• Manage payer relationships, contract interpretation, disputes, and reimbursement issues.

Provider Enrollment & Credentialing

• Coordinate credentialing and re-credentialing for physicians, NPs, PAs, dentists, dental hygienists, behavioral health providers, and other billable clinicians.
• Manage provider enrollment with Medi-Cal, Medicare, managed care plans, and commercial payers.
• Maintain accurate provider enrollment records, rosters, and required documentation.
• Coordinate provider onboarding and payer participation dates.
• Conduct required exclusion screening and maintain compliance documentation.

Compliance & Reporting

• Ensure contracting and credentialing activities meet applicable FQHC, federal, California state, and payer requirements.
• Support required reporting, audits, and regulatory reviews.
• Maintain contracting and credentialing policies and procedures.
• Work with leadership, Compliance, HR, Finance, Revenue Cycle, and Clinical teams on payer and enrollment matters.

Required Qualifications

• Bachelor's degree in Health Administration, Business, Healthcare Management, or related field, or equivalent experience.
• 3-5 years of experience in managed care contracting and/or provider credentialing.
• At least 2 years of experience in a California community health center, FQHC, or Medi-Cal participating safety-net organization.
• Strong knowledge of FQHC PPS, Medi-Cal FQHC wrap-around payments, and encounter-based billing.
• Working knowledge of California Medi-Cal managed care, DHCS policies/APLs, and CalAIM.
• Familiarity with HRSA Health Center Program requirements.
• Experience with credentialing/provider enrollment platforms and DHCS provider enrollment systems.
• Strong contract interpretation, negotiation, analytical, and financial skills.
• Excellent written and verbal communication skills.

Preferred Qualifications

• CPCS or CPMSM certification.
• Experience negotiating with California Medi-Cal Local Initiatives or County Organized Health Systems (COHS).
• Experience with CalAIM ECM and Community Supports.
• Dental and behavioral health credentialing/Medi-Cal billing experience.
• Experience supporting HRSA site visits or DHCS audits.

Additional Requirements

• Current BLS/CPR certification from an approved provider.
• Ability to complete required background and compliance checks.
• Proficiency with Microsoft Office, Word, and Excel.
• Strong organization, attention to detail, confidentiality, and time-management skills.
• Ability to work independently and collaborate across multiple departments.