Manager - Health Plan Operations

December 27, 2024

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Habitat Health

WebsiteLinkedInAll Job Openings

2 - 10 employees

Founded 2023

⚕️ Healthcare Insurance

🧘 Wellness

🌍 Social Impact

Description

• The Manager of Health Plan Ops ensures regulatory compliance in appeals and grievances, vendor management, and Health Plan reporting. • Manage vendor relationships for claims processing and Pharmacy Benefit Manager. • Coordinate with the Population Health and Compliance Quality teams to track applicable outcomes and utilization data. • Ensure credentialing, re-credentialing, and ongoing monitoring of all external vendors and internal staff members to maintain compliance with CMS and DHCS regulations.

Requirements

• 3+ years of strong customer service experience handling confidential information, including formal leadership experience. • Experience with maintaining federal and state regulatory compliance, including appeals and/or grievances. • Experience at a health plan required, PACE experience preferred. • Ability to adapt to changes and learn new systems quickly. • Excellent verbal and written communication skills. • A strong passion for our mission, with a high degree of empathy for the populations we serve. • A minimum of a Bachelor's degree in a healthcare related field preferred. • Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint)

Benefits

• Health insurance • Life insurance • Equity program participation • Paid time off, including vacation and sick leave