Manager, Member & Provider Services

Independent Living Systems, LLC•Bakersfield, CA

8d•$72,010 - $125,008

About The Position

Independent Living Systems (ILS), along with its affiliated health plans Florida Community Care and Florida Complete Care, seeks a Manager, Member & Provider Services to oversee daily contact center operations supporting members and providers. The manager ensures inquiries, concerns, and support requests are handled efficiently, accurately, and empathetically to improve satisfaction and retention. The role leads, mentors, and develops service representatives and works with health plan clients, providers, internal operational teams, compliance partners, and cross-functional teams to support service quality, regulatory compliance, and operational efficiency. The manager also monitors performance indicators and implements process improvements to advance operational excellence and 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 in accordance with HIPAA regulations.
Ability to work independently and as part of a team while balancing competing priorities and managing multiple projects.
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 inquiry resolution and First Call Resolution (FCR).
Recruit, train, and develop contact center staff, maintaining customer service and operational efficiency standards and communicating updates through regular departmental meetings.
Supervise, coach, mentor, and evaluate team members; establish and monitor standards for productivity, quality, timeliness, customer service, and professional development.
Oversee investigations and resolution of complex and escalated member and provider cases, guiding staff and ensuring compliance with applicable 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 that support accuracy, consistency, documentation integrity, and compliance.
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 and 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.