Performance Sustainability Manager – Healthy DC Plan (BHP)

Enlightened, Inc.•Washington, DC

15d•Onsite

About The Position

This role is focused on strengthening health plan operations, improving performance outcomes, and driving cross-functional execution across key business areas. The Performance Sustainability Manager is an execution-focused role responsible for driving operational performance across the Healthy DC Plan. This individual will work closely with the Director of Operations to help stabilize and scale the plan by improving key metrics, identifying operational gaps, and ensuring follow-through on critical initiatives. This role requires a strong understanding of health plan operations, including claims, eligibility, provider operations, utilization management, and member services. The ideal candidate brings structure to complex environments, proactively identifies issues, and drives solutions that improve overall plan performance.

Requirements

Bachelor’s degree required
3+ years of experience leading cross-functional initiatives
Experience driving implementation-focused change in complex environments
Strong background in health plan or payer operations (Medicaid, Exchange, or similar)
Deep understanding of health plan operations, including: Claims, eligibility, and enrollment; Provider operations and credentialing; Utilization management; Contact center/member services
Ability to identify operational breakdowns and resolve issues proactively
Experience working within health plan systems (e.g., Facets, JIVA, or similar platforms)
Strong understanding of regulatory and compliance requirements
Ability to assess downstream impacts across systems and workflows
Experience managing performance metrics and driving accountability

Nice To Haves

Master’s degree (MBA or related) preferred
Working knowledge of ACA Exchange products
Experience supporting or scaling health plan implementations
Familiarity with common operational challenges such as: Eligibility feed issues, Claims defects, Provider setup delays, Configuration gaps

Responsibilities

Develop and implement performance metrics to track progress across internal and regulatory requirements, including: Call center SLAs, Claims timeliness, Grievances and appeals, Provider credentialing, Utilization management turnaround times
Drive product strategy and planning aligned with enterprise goals, focusing on continuous improvement and measurable outcomes
Monitor progress of Healthy DC Plan initiatives, identify risks early, and ensure alignment with business objectives
Partner with executive leadership and cross-functional teams to identify and implement performance improvements
Collaborate with internal stakeholders and external vendors to achieve target performance metrics
Support business performance reporting and contribute to business reviews
Coordinate issue resolution with Medical Affairs and Provider Services related to quality of care, complaints, and grievances
Identify operational gaps and lead efforts to resolve issues related to: Claims processing, Eligibility discrepancies, Provider configuration and access, Prior authorization rules
Perform additional duties as needed