Member & Provider Services Manager - Healthcare Ops

Independent Living Systems; Richmond (CA); Presencial; USD 72.000 - 125.000; Tempo integral

Resumo da vaga

Independent Living Systems in Concord, CA is seeking a Manager, Member & Provider Services to oversee the contact center operations for members and providers in healthcare and social assistance.

The role requires a Bachelor's (and preferred Master’s) in health admin or related field, with 5+ years of experience and leadership. You will drive performance using metrics, mentor staff, and ensure regulatory compliance, including HIPAA standards.

Qualificações

• 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

• 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.

Conhecimentos

Member services experience

Provider services experience

Supervisory experience

Medi-Cal eligibility

Regulatory compliance

PHI handling / HIPAA

Flexible hours

Analytical skills

Communication skills

Formação

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

Master’s degree in Healthcare Administration, Public Health, or MBA

Ferramentas

CRM software

Electronic Health Record (EHR) systems

Descrição da vaga

Independent Living Systems in Concord, CA is seeking a Manager, Member & Provider Services to oversee the contact center operations for members and providers in healthcare and social assistance.

The role requires a Bachelor's (and preferred Master’s) in health admin or related field, with 5+ years of experience and leadership. You will drive performance using metrics, mentor staff, and ensure regulatory compliance, including HIPAA standards.