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Sr. Manager of Member Services, Fairfield, CA


Organization: Partnership HealthPlan of California
Category: Senior Manager
Location: Fairfield, CA
Date Job Posted: March 17, 2021
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Sr. Manager of Member Services

Job ID 2021-1871 FLSA Status Exempt

Overview

Manage daily operations of the Member Services Call Center and Enrollment Unit, including personnel and operational responsibilities.

Responsibilities

  • Provides day-to-day oversight and support of the Call Center and Enrollment Unit.
  • Responsible for overall management of department staff.
  • Participates in committees and meetings as needed.
  • Assists in planning, developing, and making recommendations for the organizational structure.
  • Assists the Member Services Director and Associate Directors with special assignments.
  • Oversees and assists with day-to-day operations.
  • Develops and reviews data and analytical reports, tracks interventions and results. Reports progress.
  • Develops and reviews written policies and procedures.
  • Ensures that all staff reference material is updated.
  • Mentors and develops subordinates and other staff.
  • Ensures Member Services Call Center and Enrollment training program meets the needs of the department.
  • Assists with compliance of regulatory agencies such as DHCS, DMHC, CMS, and NCQA requirements and standards.
  • Monitors phone statistics.
  • Participates in the development and revision of member materials.
  • Reviews and analyzes documentation of calls and other department activities.
  • Other duties as assigned.

SECONDARY DUTIES AND RESPONSIBILITIES

  • Leads, assigns, and participates in special projects as needed.

Qualifications

Education and Experience

Bachelor’s degree in related field and/or minimum three (3) years of management experience preferably in a Call Center and/or managed care environment. Proficient in policy development. Ability to develop data and analytical reports, track interventions and results, and report progress. Must have 3 years’ experience in managing multiple teams/skillsets

Special Skills, Licenses and Certifications

Knowledge of HMO operations preferred. Knowledge of NCQA, Federal Medicaid or California Medi-Cal and Medicare programs. Proficient knowledge of Work Force Management (WFM) administration/utilization, preferably Verint platform. Valid California driver’s license and proof of current automobile insurance compliant with PHC policy are required to operate a vehicle and travel for company business.

Performance Based Competencies

Proficiency in MS Word, Excel, and PowerPoint preferred. Demonstrated excellent leadership skills with ability to establish and motivate staff to achieve goals and objectives. Excellent interpersonal skills to ensure effective operations, meeting deadlines and standards. Excellent written and oral communication skills. Excellent customer service skills

Work Environment And Physical Demands

More than 80% of work time is spent in front of a computer monitor. Ability to move about the department freely to assist with operational functions as needed.

Additional Preferred Skills:

  • Proficient knowledge of variant workforce management platforms.
  • A minimum of (3) years experience with project lead/involvement.

All HealthPlan employees are expected to:

  • Provide the highest possible level of service to clients;
  • Promote teamwork and cooperative effort among employees;
  • Maintain safe practices; and
  • Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

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