Executive Director, Mbr. & Prov. Call Ctr Ops

Independent Living Systems • Glendale, CA

1d • $160,000 - $200,000

About The Position

The Executive Director, Member & Provider Call Center Operations, plays a pivotal role in overseeing and optimizing the operational functions (call center, referral/authorizations hub, grievance & complaint escalations hub) that directly impact both members and healthcare providers within the California Market. This position is responsible for ensuring seamless coordination and delivery of services, enhancing member satisfaction, and fostering strong provider relationships to support organizational goals. The Executive Director, Member & Provider Call Center Operations, will lead cross-functional teams to implement strategic initiatives that improve operational efficiency, compliance, and quality of care. They will serve as a key liaison between internal departments and external stakeholders, driving continuous improvement and innovation in service delivery. Ultimately, this role ensures that the organization meets its mission to provide exceptional healthcare services while maintaining regulatory compliance and financial sustainability.

Requirements

• Bachelor’s degree in Healthcare Administration, Business, Public Health, or a related field.
• At least 7 years of progressive leadership experience in healthcare operations, preferably within managed care or health plan environments.
• Demonstrated knowledge of healthcare regulations, provider network management, and member services.
• Strong experience managing large teams and complex operational functions.
• Proven ability to develop and execute strategic initiatives that improve operational performance.

Nice To Haves

• Master’s degree in Healthcare Administration, Business Administration (MBA), Public Health, or related discipline.
• Experience working with Medicaid, Medicare, or commercial health plans.
• Familiarity with healthcare IT systems, claims adjudication platforms, and data analytics tools.
• Certification in healthcare management or project management (e.g., PMP, CPHQ).
• Experience in change management and process improvement methodologies such as Lean or Six Sigma.

Responsibilities

• Lead and manage all aspects of member and provider operations, including enrollment, claims processing, provider network management, and customer service.
• Develop and implement operational strategies that enhance member experience and provider engagement while ensuring compliance with healthcare regulations and policies.
• Collaborate with clinical, finance, and IT teams to streamline processes, improve data accuracy, and support technology integration for operational excellence.
• Monitor key performance indicators and operational metrics to identify areas for improvement and drive corrective actions.
• Represent the organization in meetings with providers, members, regulatory agencies, and other stakeholders to advocate for operational priorities and resolve issues.

What This Job Offers

• Job Type: Full-time
• Career Level: Executive