Manager, Member & Provider Services

Independent Living Systems•Richmond, CA

About The Position

Independent Living Systems (ILS), along with its affiliated health plans Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for vulnerable populations. The Manager, Member & Provider Services oversees daily contact center operations supporting members and providers in the healthcare and social assistance sector. The role ensures inquiries, concerns, and support requests are addressed efficiently, accurately, and empathetically to enhance satisfaction and retention. The manager leads, mentors, and develops member and provider services representatives, fostering continuous improvement and high performance. Working with health plan clients, providers, internal operational teams, compliance partners, and other cross-functional teams, the manager supports exceptional service delivery, regulatory compliance, quality outcomes, and operational efficiency. The position also implements process improvements, monitors key performance indicators, and drives operational excellence in support of the organization's mission.

Requirements

Bachelor’s degree in Healthcare Administration, Business, or a related field.
At least 5 years of member or provider services experience in the healthcare or social assistance industry.
At least 2 years of supervisory experience.
Experience with Medi-Cal eligibility and benefits.
Demonstrated experience using operational metrics, reports, and quality audits to drive performance improvements.
Strong organizational, analytical, and time-management skills, including the ability to manage multiple priorities and deadlines.
Excellent communication, organizational, and interpersonal skills.
Ability to maintain confidentiality and handle protected health information (PHI) in accordance with HIPAA regulations.
Ability to work independently and as part of a team while balancing competing priorities and managing multiple projects simultaneously.
Ability to work flexible hours as needed to support operational requirements.

Nice To Haves

Master’s degree in Healthcare Administration, Public Health, or Business Administration.
Experience with healthcare information systems and customer relationship management (CRM) software.
Experience in care management, Enhanced Care Management (ECM), Community Supports, housing navigation, or related healthcare service delivery programs.
Experience with electronic health record (EHR) systems.

Responsibilities

Demonstrate commitment to the organization's mission and model ILS Experience Standards of Excellence.
Lead and manage daily Contact Center operations, ensuring timely and effective resolution of inquiries and issues and promoting First Call Resolution (FCR).
Recruit, train, and develop contact center staff, maintaining high customer service and operational efficiency standards and communicating updates through regular departmental meetings.
Supervise, coach, mentor, and evaluate team members; establish and monitor productivity, quality, timeliness, customer service, and professional development standards to achieve departmental objectives.
Oversee investigation and resolution of complex and escalated member and provider cases, guide staff, and ensure compliance with contractual, regulatory, organizational, and client-specific requirements.
Monitor regulatory turnaround times, service level agreements, and operational performance metrics to support timely resolution, quality outcomes, and customer satisfaction.
Develop, implement, and maintain quality assurance programs, operational procedures, workflows, training materials, and performance standards to support accuracy, consistency, documentation integrity, and compliance across 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; participate in audits, regulatory reviews, client reporting, and quality improvement activities.
Attend scheduled meetings, trainings, leadership forums, and cross-functional workgroups.
Perform other duties as assigned.