Member & Provider Services Manager (Healthcare Ops)

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

Job summary

Independent Living Systems (ILS) in San Diego, CA, seeks a Manager, Member & Provider Services to lead the contact center for members and providers in the health and social services space. You will recruit, train, and mentor staff, drive first call resolution, and ensure HIPAA compliance while partnering with health plans and clients to improve service delivery and outcomes.

Ideal candidates will have a Bachelor’s degree in Healthcare Administration or related field and at least five years in

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.
• At least 2 years in a supervisory role.
• Experience with Medi-Cal eligibility and benefits.
• Strong organizational, analytical, and time-management skills.
• Ability to work flexible hours as needed.
• HIPAA compliance experience.

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.

Skills

Leadership

Healthcare administration

CRM software

HIPAA privacy

Regulatory compliance

Education

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

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

Tools

CRM software

Electronic Health Records (EHR)

Job description

Independent Living Systems (ILS) in San Diego, CA, seeks a Manager, Member & Provider Services to lead the contact center for members and providers in the health and social services space. You will recruit, train, and mentor staff, drive first call resolution, and ensure HIPAA compliance while partnering with health plans and clients to improve service delivery and outcomes.

Ideal candidates will have a Bachelor’s degree in Healthcare Administration or related field and at least five years in