Job Summary: This role presents an exciting opportunity for a detail-oriented, operationally strong professional to support the build-out and day-to-day functioning of operations for a new PACE program. The Manager will be responsible for executing and coordinating key operational workflows across enrollment, provider relations and care coordination, working closely with senior leadership to ensure participant-centered service delivery.
Essential Job FunctionsEnrollment & Eligibility Operations- Manage participant enrollment and disenrollment workflows, including CMS and DHCS submission tracking
- Support Medi-Cal and Medicare eligibility verification and redetermination processes
- Identify and escalate enrollment-related issues to ensure eligibility continuity for participants
- Supervise, coach, and develop Intake Coordinator(s) and Outreach and Enrollment Coordinators; set clear expectations, provide feedback, and support professional growth.
- Ensure that the enrollment targets are met every month by coordinating intake team staffing, and coverage
- Establish and maintain standard work, training, and job aids for intake workflows; onboard new team members as the program scales.
Provider Network & Relations- Support provider network operations including provider data maintenance, credentialing coordination, and access management
- Serve as an operational point of contact for provider relations, issue resolution, and escalation workflows
- Monitor network adequacy and service level concerns, escalating as appropriate
Credentialing and Delegated Oversight Support- Coordinate delegated credentialing and compliance requirements with providers and internal teams.
- Support ongoing monitoring processes (for example, OIG exclusion checks and documentation of required attestations) in partnership with compliance/quality and health plan operations.
- Track and document provider compliance with contract requirements, including timeliness of medical record return and participation in required trainings.
Care Coordination & Referral Operations- Coordinate centralized referral workflows and external appointment scheduling processes
- Ensure timely specialty scheduling, visit note retrieval, and participant follow-through
- Collaborate with Clinical Operations and IDT teams on care transitions and participant access issues
Team & Operational Support- May oversee one or more operational staff or coordinators as the team grows
- Contribute to workforce and process improvement initiatives as census scales
Minimum Qualifications- Bachelor's degree in healthcare administration, business, public health, or related field, or equivalent relevant experience.
- 3+ years of experience in provider network management, contracting, provider relations, or health plan operations.
- Strong communication, relationship-building, and issue resolution skills.
- High attention to detail and ability to manage multiple deadlines in a fast-moving startup environment.
- Comfort operating in evolving, build-as-you-go environments preferred
Preferred Qualifications- Master's degree in Business Administration (MBA), Health Administration (MHA), or related field
- Supervisory or lead experience in health plan operations
- Experience in a startup or high-growth healthcare environment
- Strong attention to detail and follow-through
- Ability to manage multiple workflows and competing priorities
- Clear, collaborative communication across teams
- Comfort with ambiguity and a continuous improvement mindset
- Analytical and process-oriented approach to problem-solving
$115,000 - $138,000 a year
Benefits That Support YouWe're committed to supporting our team's well-being. Our comprehensive benefits package includes:
Health & Wellness- 100% employer-paid medical, dental & vision coverage
- Acupuncture & chiropractic coverage
Time Off- 12 vacation days
- 12 sick days
- 12 paid holidays + 3 floating holidays (additional flexible days you can use anytime)
Financial & Retirement- 403(b) with 3% employer contribution + up to 2% match
- Flexible Spending Account (FSA) & Dependent Care Assistance
Additional Support- Commuter benefits
- Long-Term Disability Insurance
Please note: We are not seeking support from staffing agencies at this time. Direct applicants only.
