Medi-Cal Provider/Member Services Organization Research Manager- West Sacramento, CA (Hybrid)

Gainwell Technologies LLC•Any city, OH

13d•$81,000 - $115,700•Hybrid

About The Position

The Medi-Cal Provider/Member Services Organization Research Manager role requires a forward-thinking leader who can apply analytical rigor and strategic insight to support long-term planning, evaluate emerging policy and program changes, and drive operational improvement. Strong communication and relationship-building skills are essential to foster cross-functional collaboration, align stakeholders, and influence decisions across operational, training, quality, policy, and client-facing areas through data-driven recommendations and trusted partnerships.

Requirements

Minimum of 5 years of leadership experience within a healthcare, managed care, Medicaid, or healthcare operations environment.
Bachelor’s degree in Healthcare Administration, Business Administration, or related field preferred; equivalent leadership experience will also be considered.
Strong leadership, communication, coaching, presentation, stakeholder management, and problem-solving skills with the ability to influence and motivate teams.
Regular interaction with executive leadership, operational stakeholders, clients, and cross-functional teams.
Strong understanding of HIPAA Privacy and Security Rules, Medicaid guidelines, quality assurance standards, and healthcare customer service operations.
Experience managing high-volume inbound and outbound back office operations, analyzing operational metrics such quality scores, staffing trends, productivity, and customer experience data.
Opportunities to lead workforce optimization, operational improvements, client engagement initiatives, and performance enhancement strategies.

Responsibilities

Serve as a key operational leader, driving client engagement, performance improvement, workforce optimization, and collaboration with executive leadership and key stakeholders.
Lead Provider and Member Services back-office operations, overseeing inbound and outbound functions, staffing, quality performance, compliance, leader and team development to ensure exceptional service delivery and achievement of performance goals.
Monitor operational metrics for back-office teams, as contractually defined, in addition to corporate measures and standards. This includes but is not limited to escalation management, research, outreach, expert witness and court ordered services, quality scores, productivity, attendance, and customer experience trends while implementing action plans for continuous improvement.
Maintain strong client relationships by leading scheduled meetings, coordinating deliverables, communicating operational updates, and addressing escalated concerns professionally and proactively.
Ensure compliance with HIPAA Privacy and Security Rules, Medicaid guidelines, internal policies, and quality assurance standards across all operational activities.